Key result
An 82-year-old male developed right atrial perforation with pericardial and pleural effusions seven days after permanent pacemaker implantation, which was successfully managed conservatively.
Case Report (n=1)
No
Right atrial perforation after pacemaker implantation can present atypically with dyspnea and hypoxemia, and may be managed conservatively without lead extraction if the patient remains hemodynamically stable.
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Delayed perforation after pacemaker implantation may permit conservative management in stable patients; this case leaves open optimal strategies beyond extraction.
An 82-year-old male patient, who underwent permanent DDDR pacemaker implantation due to Mobitz II type AV block, attended the emergency room due to limiting dyspnoea seven days after hospital discharge. Mild hypoxemia was observed in the emergency room and he was admitted for observation and monitoring. On the ward, a regulated echocardiography was performed, revealing pericardial effusion without right chamber collapse and left pleural effusion causing complete atelectasis of the basal lobe, and a chest CT scan was scheduled to confirm the diagnosis of atrial perforation. Treatment was performed conservatively with clinical observation and drainage of both effusions, without the need to remove and reimplant the pacemaker leads.
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Pérez-Ajami et al. (2024) conducted a case report in Right atrial perforation after permanent pacemaker implantation (n=1). Permanent DDDR pacemaker implantation was evaluated. An 82-year-old male developed right atrial perforation with pericardial and pleural effusions seven days after permanent pacemaker implantation, which was successfully managed conservatively.
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