Key result
Temporary transvenous pacing leads to right ventricular perforation and acute cardiac tamponade requiring emergency surgery.
Why the study?
Temporary transvenous pacing for symptomatic complete heart block can lead to serious complications including right ventricular perforation and acute cardiac tamponade.
Case Report (n=1)
Acute hypotension after temporary pacing should prompt immediate evaluation for cardiac tamponade, as right ventricular perforation can occur and may require emergency surgery.
Answers are grounded in this paper and cite their sources.
Hypotension after temporary transvenous pacing warrants urgent tamponade evaluation; this case leaves open the true incidence of RV perforation.
BACKGROUND: Although temporary transvenous pacing is a lifesaving therapy for symptomatic complete heart block, the procedure may also lead to serious complications such as right ventricular perforation and acute cardiac tamponade. CASE SUMMARY: A 76-year-old woman with ischemic heart disease developed symptomatic complete atrioventricular block and severe bradycardia. A temporary transvenous pacemaker was inserted through the right femoral vein with the lead positioned at the right ventricular apex. Within 15 minutes, the patient experienced hypotension, decreased consciousness, and pacing dysfunction. Bedside echocardiography revealed a large pericardial effusion consistent with acute cardiac tamponade. Pericardiocentesis was ineffective owing to clotted hemopericardium, prompting emergency surgery that confirmed right ventricular perforation and allowed successful repair. DISCUSSION: This case demonstrates that temporary transvenous pacing, though routine, carries a risk of serious iatrogenic complications in elderly patients. TAKE-HOME MESSAGE: Acute hypotension after temporary pacing should prompt immediate evaluation for cardiac tamponade; early diagnosis and timely surgery are essential to improving outcomes.
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Chandra et al. (2026) conducted a case report in Symptomatic complete atrioventricular block and severe bradycardia (n=1). Temporary transvenous pacing was evaluated on Acute cardiac tamponade caused by right ventricular perforation. Temporary transvenous pacing in a 76-year-old woman led to right ventricular perforation and acute cardiac tamponade, requiring emergency surgical repair after ineffective pericardiocentesis.
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