A case report of pacemaker lead perforation causing late pericardial effusion and subacute cardiac tamponade

Despite medical therapy, the overall prognosis for heart failure (HF) remains poor with high rates of sudden death and death from progressive HF. Device-based therapies offer considerable promise both for the relief of symptoms and for improving prognosis. Cardiac resynchronization therapy is a relatively new and effective treatment for patients with moderate to severe systolic HF and ventricular dyssynchrony. Clinical trials have demonstrated an improvement in quality of life, improved exercise tolerance, decreased HF hospitalizations, and improved survival. Complication rates for patients receiving cardiac pacemakers are relatively low. Although rare, cardiac tamponade caused by myocardial perforation during pacing lead insertion usually occurs a short time after the procedure. This case study discusses a patient who presented with cardiac tamponade 4 months after pacemaker implant. A small perforation of the right atrial lead caused a slow effusion into the pericardial sac. The patient's unusual presentation, hospital course, pathophysiology, and treatment for cardiac tamponade are discussed.