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Late Cardiac Tamponade as a Result of Parietal Pericardium Erosion

Stanislaw Tubek1, Piotr Niewinski1, Dariusz Jagielski2

  • 1Department of Cardiology, 4(th) Military Hospital, Wroclaw, Poland; Department of Heart Disease, Faculty of Health Sciences, Medical University in Wroclaw, Wroclaw, Poland.

The Annals of Thoracic Surgery
|August 4, 2015
PubMed

Insights

Late cardiac tamponade after implantable cardioverter-defibrillator (ICD) lead placement is rare. A unique case revealed a pressure sore from the ICD lead causing fatal cardiogenic shock, highlighting the need for awareness.

Area of Science:

  • Cardiology
  • Medical Devices
  • Surgical Complications

Background:

  • Late-onset cardiac tamponade is a rare complication following intracardiac lead implantation.
  • Implantable cardioverter-defibritors (ICDs) are crucial for managing cardiac arrhythmias.
  • Diagnostic and management challenges exist for delayed complications of cardiac device leads.

Observation:

  • A case of cardiac tamponade leading to cardiogenic shock occurred 1,164 days post-ICD implantation.
  • Surgical exploration revealed an uncommonly reported mechanism: a pressure sore caused by the ICD lead on the parietal pericardium.
  • No visible damage to the visceral pericardium was noted.

Findings:

  • The pressure sore on the parietal pericardium was the direct cause of the tamponade.
  • This specific lead-induced pericardial erosion is a novel finding.
  • The delayed presentation underscores the potential for late-stage device-related issues.

Implications:

  • Prompt diagnosis and surgical intervention are critical for managing this rare complication.
  • Physicians must consider lead-induced pericardial erosion as a potential cause of late cardiac tamponade.
  • Increased awareness of this pathomechanism can prevent fatal outcomes associated with conservative management.

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