Unintended Consequence – Iatrogenic Acute Pericarditis Following Right Ventricular Perforation by Temporary Pacemaker Lead in Total Atrioventricular Block

Acute pericarditis is an uncommon but clinically significant complication of cardiac instrumentation that requires prompt recognition. This report describes a 48-year-old male with total AV block (TAVB) who developed iatrogenic acute pericarditis due to right ventricular (RV) perforation caused by a temporary pacemaker (TPM) lead. Imaging showed a lead protrusion through the posterior RV apex. Surgical exploration showed a thin-walled RV perforation with 300 mL of serous pericardial effusion and fibrin deposition. Primary RV repair was performed with 6-0 polypropylene sutures, and the TPM lead was removed. Postoperatively, the patient developed pleuritic chest pain and a pericardial friction rub. Cardiac computed tomography showed anterior and anterolateral pericardial thickening with minimal effusion, consistent with acute pericarditis. Iatrogenic myocardial injury may activate inflammasome pathways, driving sterile pericardial inflammation. The treatment with ibuprofen and colchicine led to rapid symptom resolution, C-reactive protein reduction, and near-complete effusion regression in 1 week without recurrence. This case underscores the need for prompt diagnosis and management of acute pericarditis associated with TPM-related RV perforation.