SHM Converge Scientific Abstract ePoster Gallery-Chronic Pacemaker Lead Perforation Into the Right Ventricle: A Rare Cause of Pericardial Effusion and Chest Pain

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This case report describes a 63-year-old woman with multiple comorbidities, including atrial fibrillation on apixaban, coronary artery disease, COPD, and a biventricular pacemaker, who presented with one week of persistent chest pain, worsening shortness of breath, and bilateral leg pain. Physical examination showed mottling of the lower extremities, and laboratory testing revealed leukocytosis. CT imaging of the chest demonstrated perforation of the right ventricular wall by a pacemaker lead with a moderate pericardial effusion, though there was no tamponade.<br /><br />Because of the risk of progression to life-threatening complications, she was admitted to the ICU for close monitoring. A multidisciplinary team involving interventional cardiology and cardiac surgery performed a thoracotomy. The lead was extracted, the pacemaker was replaced, and the right ventricular myocardial wall was repaired. Intraoperative findings showed perforation near the apical region of the right ventricle close to the septum. The procedure was successful, and postoperative echocardiography confirmed a stable pericardial effusion.<br /><br />The report emphasizes that pacemaker lead perforation is a rare but serious complication, with reported prevalence ranging from 0.1% to 6%. Chronic perforation, occurring more than 30 days after implantation, is especially uncommon but can present with chest pain, dyspnea, and pericardial effusion. Risk factors include advanced age, frailty, coagulopathy, and procedural or device-related factors.<br /><br />The key clinical message is that prompt recognition, early CT imaging, and rapid surgical intervention are essential, especially in pacemaker-dependent patients. Multidisciplinary collaboration is critical to preventing severe cardiac injury and improving outcomes.

Asset Subtitle

Zein Barakat

Meta Tag

Author List Adeeb Mustafa, Michael Sabina, Paola Campillo, Zein Barakat

Category Clinical Vignettes

Concept Pacemaker Lead Perforation

Concept Pericardial Effusion

Concept Cardiac Perforation

Concept Surgical Lead Extraction

Concept Cardiac Tamponade

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Zein Barakat

Track Adult

Keywords

pacemaker lead perforation

right ventricular perforation

pericardial effusion

chest pain

dyspnea

computed tomography

thoracotomy

lead extraction

cardiac surgery

multidisciplinary management

Pacemaker Lead Perforation

Pericardial Effusion

Cardiac Perforation

Surgical Lead Extraction

Cardiac Tamponade