Right coronary artery perforation by an active-fixation atrial pacing lead resulting in life-threatening tamponade

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Device Complications

Background:

• Cardiac tamponade is a rare but serious complication following pacemaker implantation.
• Perforation of cardiac chambers or major vessels can lead to hemopericardium and hemodynamic instability.

Purpose of the Study:

• To report the first case of right coronary artery perforation caused by a screw-in atrial pacing lead.
• To emphasize the importance of considering coronary artery perforation in the differential diagnosis of cardiac tamponade post-pacemaker implantation.

Main Methods:

• A 72-year-old female patient with complete atrioventricular block underwent permanent pacemaker implantation.
• The patient developed acute hypotension and cardiac tamponade hours after the procedure.
• Diagnosis was confirmed via echocardiography, and the perforation was identified and repaired during thoracotomy.

Main Results:

• The patient presented with symptoms of cardiac tamponade, including severe hypotension, approximately 3.5 hours post-pacemaker implantation.
• Echocardiography revealed a large pericardial effusion.
• Intraoperative findings during thoracotomy showed a perforation of the right coronary artery by the tip of the atrial pacing lead, with massive hemopericardium. The perforation was successfully repaired.

Conclusions:

• Perforation of the right coronary artery is a potential, albeit rare, complication of atrial pacemaker lead implantation.
• Clinicians should maintain a high index of suspicion for coronary artery perforation in patients presenting with cardiac tamponade after pacemaker procedures.