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Pneumopericardium caused by a permanent endocardial pacing lead
Akihito Matsushita1, Tatsuhiko Komiya, Nobushige Tamura
1Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan. akihito_matsu@yahoo.co.jp
Interactive Cardiovascular and Thoracic Surgery
|September 11, 2008
Summary
A rare complication of pacemaker implantation occurred when a pacing lead perforated the right atrium and lodged in the lung. Prompt surgical removal was necessary to treat pneumopericardium and lung injury.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Device Complications
Background:
- A 59-year-old female patient with a history of bronchiectasis presented with fever and hemosputum.
- She had previously undergone permanent pacemaker (DDD mode, screw-in lead) implantation for complete atrioventricular block.
Observation:
- Computed tomography revealed pneumopericardium (air in the pericardial sac).
- The right atrium pacing lead was found to have perforated the heart wall and was embedded in the right lung.
Findings:
- A semi-emergency right thoracotomy was performed.
- Surgical intervention successfully removed the pacing lead and a portion of the right middle lobe.
Implications:
- Pacing lead perforation, though infrequent, is a critical complication that can lead to serious conditions like pneumopericardium.
- This case underscores the importance of considering lead perforation in patients with relevant symptoms post-pacemaker implantation.
- Early diagnosis and surgical intervention are crucial for managing this rare but potentially life-threatening event.
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