An unusual presentation of delayed lead perforation: It’s never too late

Figures

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  Figure 1. Transthoracic echocardiogram images. A: Parasternal short-axis view at end diastole showing a large circumferential pericardial effusion. B: Subxiphoid view showing large pericardial effusion.

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  Figure 2. Computed tomographic imaging of the chest. A: Axial images. B: Coronal images. C: Sagittal images. Images show moderate-to-large hemopericardium (white arrows) and perforation of the right ventricular lead (yellow circle).

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  Figure 3. Device interrogation: stable right ventricular (RV) lead pacing and defibrillator impedances. Acute increase in RV pacing threshold from <0.75 V @ 0.4 ms to >2.5 V @ 0.4 ms. Decrease in the R-wave amplitude from an average of 6 V to <4 V.

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  Supplemental Figure 1. Plain film X-ray imaging showing a comparison of post-implant device placement versus admission position. (A) February 2014, post implantation showing RA, RV and CS lead positions. (B) September 2020, admission images showing stable RA, RV and CS lead positions. Significantly the image shows evidence of enlarged cardiac silhouette, specifically pericardial silhouette (marked by red arrows). No gross movement in the lead position seen on comparing both images.