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Right ventricular lead perforation with iatrogenic injury to an intercostal artery causing haemothorax after

Anna Björkenheim1, Torbjörn Kalm2, Mats Lidén3

  • 1Department of Cardiology, School of Medical Sciences Campus USÖ, Örebro, Sweden anna.bjorkenheim@regionorebrolan.se.

BMJ Case Reports
|February 8, 2024
PubMed

Insights

Pacemaker lead perforation can cause severe bleeding into the chest (hemothorax). Early diagnosis with CT scans and prompt cardiothoracic surgery are crucial for managing this life-threatening complication.

Area of Science:

  • Cardiology
  • Cardiothoracic Surgery
  • Medical Imaging

Background:

  • Pacemaker implantation is a common procedure, but carries risks of complications.
  • Subacute lead perforation is a rare but serious complication.
  • Iatrogenic injury to adjacent vascular structures can lead to significant hemorrhage.

Observation:

  • An elderly female patient developed a large hemothorax following pacemaker implantation.
  • CT imaging revealed active bleeding from an intercostal artery due to lead perforation.
  • The patient presented with a life-threatening complication requiring urgent surgical intervention.

Findings:

  • Successful surgical management involved sealing the bleeding intercostal artery.
  • A new epicardial lead was implanted, and the perforating lead was removed.
  • The patient's condition stabilized following the cardiothoracic surgery.

Implications:

  • This case highlights the critical importance of recognizing severe consequences of pacemaker lead perforation.
  • Timely diagnosis using CT scans and prompt intervention in specialized cardiothoracic units are essential.
  • Effective management relies on a multidisciplinary approach involving cardiology and cardiothoracic surgery.

Keywords:
Cardiothoracic surgeryPacing and electrophysiologyRadiology (diagnostics)

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