Delayed Presentation of Pericardial Tamponade Resulting From Permanent Pacemaker Lead Perforation

Permanent pacemaker placement may be associated with several complications. This case report describes an 86-year-old male with a history of pacemaker placement five weeks prior, who presented to the emergency department via ambulance with concerns for acute occlusive myocardial infarction on electrocardiogram. He was found to have pericardial tamponade secondary to the puncture of the right ventricular wall by the pacer wire. This case report represents a rare, life-threatening complication of pacemaker placement. Recognition of this complication by emergency physicians is imperative and can rapidly change management. Treatment of pericardial tamponade can vary depending on patient stability; however, it ultimately requires drainage either surgically or with drain placement. Patients with pacemaker lead migration require revision of their pacemaker to prevent future complications.