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Three-dimensional echocardiographic documentation of pacemaker lead perforation presenting as acute pericarditis

Alexandros S Stefanidis1, Panagiotis N Margos, Athanasios A Kotsakis

  • 11st Department of Cardiology, General Hospital of Nicea, Piraeus, Greece. plato203@yahoo.com

Hellenic Journal of Cardiology : HJC = Hellenike Kardiologike Epitheorese
|July 23, 2009
PubMed

Insights

Myocardial perforation from pacemaker leads is rare but serious. Real-time 3D echocardiography is superior to CT for diagnosing this complication, even when CT is initially undetected.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Myocardial perforation is a rare complication of permanent pacemaker implantation.
  • Pericardial effusion frequently co-occurs, complicating diagnosis due to multiple potential causes.

Observation:

  • A case of ventricular perforation causing pericarditis is presented.
  • Computed tomography (CT) initially failed to detect the lead perforation.
  • The complication was ultimately diagnosed using real-time three-dimensional echocardiography.

Findings:

  • Real-time 3D echocardiography demonstrated superior diagnostic accuracy for myocardial perforation compared to CT.
  • Echocardiography effectively identified ventricular perforation and associated pericarditis.

Implications:

  • This case highlights the diagnostic challenges of pacemaker-related myocardial perforation.
  • Real-time 3D echocardiography should be considered a valuable tool for diagnosing pacemaker lead perforation.
  • Improved diagnostic strategies are needed for this rare but significant complication.

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