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Brief report: 2D-echo diagnosis of interventricular septal perforation by a temporary pacing electrode
1Division of Cardiology, Hospital Fatebenefratelli S. Orsola, Brescia.
Insights
A rare case of temporary pacemaker lead perforation through the interventricular septum occurred in an 83-year-old patient with hypertensive heart disease. The patient recovered fully and underwent permanent pacemaker implantation.
Area of Science:
- Cardiology
- Medical Devices
Background:
- An 83-year-old patient with hypertensive cardiopathy presented with left ventricular failure and complete atrioventricular block.
- A temporary pacing electrode was inserted via the right internal jugular vein.
Observation:
- A routine 2D-echocardiogram revealed the catheter tip within the left ventricular cavity.
- Interventricular septal perforation was confirmed by the development of a right bundle branch block pattern on surface electrocardiogram.
Findings:
- The patient experienced a complication of temporary pacemaker lead placement: interventricular septal perforation.
- Despite the perforation, the clinical course was event-free.
Implications:
- This case highlights a rare but serious complication associated with temporary pacemaker lead insertion.
- Early diagnosis via echocardiography and electrocardiography is crucial for managing such events.
- Successful management and transition to permanent pacing were achieved.
Abstract:
We report the case of an 83-year-old patient affected by hypertensive cardiopathy and admitted to our Division for left ventricular failure and complete atrioventricular block; a temporary electrode was inserted via the right internal jugular vein. A routine 2D-echo examination performed one day later clearly showed the catheter tip in the left ventricular cavity; the interventricular septal perforation was confirmed by the presence of right bundle branch block pattern on surface electrocardiogram. The following clinical course was totally event-free and the patient eventually underwent permanent pacing. A comparison with the few cases of pacing-related myocardial perforations so far described by the literature is made.