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Cardiac tamponade due to right coronary artery perforation following pacemaker implantation: a case report

Zakaria Alaoui-Ismaili1, Anika Klein1, Jacob Eifer Moeller1,2

  • 1Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.

European Heart Journal. Case Reports
|July 29, 2024
PubMed
Abstract

Insights

Cardiac tamponade after permanent pacemaker (PM) implantation is rare. This case highlights right coronary artery (RCA) perforation as a cause, emphasizing prompt diagnosis and surgical management.

Area of Science:

  • Cardiology
  • Medical Devices
  • Interventional Cardiology

Background:

  • Permanent pacemaker (PM) implantation is a common procedure.
  • Cardiac tamponade is a rare but serious complication of PM implantation, occurring in 0.3% of cases.
  • Right coronary artery (RCA) perforation is an exceptionally rare complication of PM implantation.

Observation:

  • A 75-year-old woman presented with shock due to cardiac tamponade 4 days after PM implantation.
  • Initial assessment included blood gas analysis of pericardial effusion, suggesting arterial bleeding.
  • Computed tomography (CT) scan identified RCA perforation as the source of bleeding.

Findings:

  • The patient underwent surgical management for the RCA perforation.
  • This case represents one of the few reported instances of RCA perforation post-PM implantation.
  • Successful surgical intervention resolved the life-threatening cardiac tamponade.

Implications:

  • Coronary artery perforation should be considered in the differential diagnosis of cardiac tamponade after PM implantation.
  • Blood gas analysis of pericardial effusion is a valuable diagnostic tool in such cases.
  • Early identification and surgical intervention are crucial for managing this rare complication.
Keywords:
Active-fixation (screw-in) leadCardiac tamponadeCase reportPacemaker implantationRight coronary artery perforation

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