Cardiac Tamponade after Right Ventricular Perforation Caused by Screw-in Lead

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Medical Device Complications

Background:

• Permanent dual-chamber pacemaker implantation is a common procedure for cardiac rhythm management.
• Complications, though rare, can arise from implanted cardiac electronic devices.
• Active-fixation (screw-in) leads are used for secure atrial and ventricular lead placement.

Observation:

• A 69-year-old male presented with syncope, chest pain, and cardiac tamponade three weeks post-pacemaker implantation.
• Transthoracic echocardiography revealed a significant pericardial effusion.
• Multislice computed tomography confirmed right ventricular perforation by the active-fixation pacemaker lead.

Findings:

• The patient's cardiac tamponade was successfully treated with urgent pericardial drainage.
• Right ventricular perforation due to an active-fixation pacemaker lead was identified as the cause.
• Lead extraction under fluoroscopy and echocardiographic guidance, with surgical backup, was performed successfully.

Implications:

• This case highlights a rare but serious complication of active-fixation pacemaker leads.
• Prompt diagnosis and intervention, including lead extraction and drainage, are crucial for patient survival.
• The successful implantation of a passive-fixation lead suggests an alternative for patients with high perforation risk.