Lead Perforation Into the Left Internal Mammary Artery Causing Circulatory Collapse After Pacemaker Insertion

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Device Complications

Background:

• Pacemaker implantation is a common procedure for managing symptomatic bradycardia.
• Ventricular perforation is a known but infrequent complication of pacemaker lead placement.
• Hemorrhage into adjacent vascular structures can lead to severe hemodynamic compromise.

Purpose of the Study:

• To report a rare case of pacemaker lead perforation.
• To describe the subsequent hemorrhage into the left internal mammary artery.
• To emphasize the potential for life-threatening complications during pacemaker implantation.

Main Methods:

• A 66-year-old female patient underwent pacemaker implantation.
• The pacemaker lead inadvertently perforated the ventricle.
• The lead traversed into the left internal mammary artery, causing hemorrhage.

Main Results:

• The lead perforation resulted in slow hemorrhage into the left internal mammary artery.
• The patient experienced circulatory collapse and shock.
• This represents a rare and critical complication of pacemaker implantation.

Conclusions:

• Pacemaker lead perforation into the left internal mammary artery is a rare but potentially fatal complication.
• Prompt recognition and management are crucial for patients presenting with shock post-pacemaker insertion.
• This case underscores the importance of meticulous technique during cardiac device implantation.