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The postcardiotomy syndrome following transvenous pacemaker insertion.
Pacing and Clinical Electrophysiology : PACE
|July 1, 1987
Summary
A rare syndrome of fever, pericarditis, and pericardial effusion occurred two months after permanent pacemaker insertion. Treatment with pericardiocentesis and indomethacin led to resolution, suggesting inadvertent cardiac perforation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- Permanent pacemaker insertion is a common procedure for managing bradyarrhythmias.
- Complications, though rare, can arise from transvenous lead placement.
- Postcardiotomy syndrome is a known, albeit infrequent, complication following cardiac surgery.
Observation:
- A 75-year-old woman developed fever, pericarditis, and symptomatic pericardial effusion two months post-pacemaker implantation.
- The patient's symptoms emerged insidiously, several weeks after the initial procedure.
- Initial presentation mimicked infectious or inflammatory etiologies.
Findings:
- Pericardial effusion was confirmed and successfully treated with pericardiocentesis.
- Subsequent administration of indomethacin led to complete resolution of symptoms.
- The clinical timeline and resolution pattern suggest a link to the pacemaker insertion.
Implications:
- This case highlights a potential, unrecognized complication of permanent pacemaker insertion: postcardiotomy syndrome.
- Inadvertent cardiac perforation, even if not immediately apparent, should be considered in the differential diagnosis.
- Early recognition and management with pericardiocentesis and anti-inflammatory agents may prevent serious sequelae.