Key result
Surgical repair via median sternotomy successfully treated a life-threatening right atrial and right lung perforation caused by a pacemaker atrial lead in a 65-year-old woman.
Case Report (n=1)
No
Active fixation atrial leads can rarely cause delayed, life-threatening perforation of the right atrium and lung, necessitating high clinical suspicion and prompt surgical repair.
May warrant consideration of surgical repair for pacemaker lead perforation; leaves open optimal strategies pending larger studies.
We report the case of a 65-year old female patient who was urgently admitted to our institution with hemothorax after pacemaker implantation. The bichamber pacemaker had been implanted one week before admission and the active fixation lead caused perforation of the right atrial wall and penetration of the right lung. Transthoracic echocardiography demonstrated a minimal cardiac effusion but chest X-Ray and computed Tomography (CT) visualised the atrial screw helix outside the atrial wall penetrating through the right lung middle lobe causing hemothorax. After median sternotomy and cut-off of the atrial lead screw helix, we sew the perforated area of the right atrium and the penetrated right lung, sucking away the bloody pleural effusion before closing the thorax. Three weeks later, the cut off atrial lead was extracted through the right subclavian vein and a new one was positioned and fixed again. During the hospital admission the patient was well and free of any symptoms and troubles.
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A 2015 study conducted a case report in Pacemaker atrial lead perforation (n=1). Surgical repair of perforated atrial lead was evaluated on Patient recovery and symptom resolution. Surgical repair via median sternotomy successfully treated a life-threatening right atrial and right lung perforation caused by a pacemaker atrial lead in a 65-year-old woman.
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