Successful Management of Right Ventricular Perforation Associated with a Pacemaker Lead During Off-Pump CABG Surgery:...

Area of Science:

• Cardiovascular Surgery
• Electrophysiology
• Cardiac Pacing

Background:

• Intraoperative right ventricular perforation from a pacing catheter is a rare complication following successful pacemaker insertion.
• This case involves a 68-year-old male with a history of permanent pacemaker implantation for symptomatic complete atrioventricular block.
• The patient presented with 3-vessel coronary artery disease requiring off-pump coronary artery bypass graft surgery.

Observation:

• During off-pump coronary artery bypass graft surgery, the permanent pacemaker lead perforated the right ventricle.
• The patient experienced sudden cardiac arrest immediately following the perforation event.
• Emergency on-pump cardiac surgery was initiated for resuscitation and management.

Findings:

• Pacemaker lead perforation of the right ventricle can occur intraoperatively, even after uneventful lead placement.
• This complication can precipitate life-threatening events such as cardiac arrest during cardiac surgery.
• Prompt surgical intervention is crucial for managing cardiac perforation and associated arrest.

Implications:

• This case underscores the potential for severe complications from pacemaker leads during cardiac procedures.
• It highlights the necessity of preparedness for emergency interventions in cases of cardiac perforation.
• Emergency surgery may be a critical, life-saving measure for patients experiencing cardiac arrest due to pacemaker lead perforation.