This case highlights that cardiac tamponade following screw-in atrial lead placement can result from pericardial oozing due to scratching of the inner pericardial membrane, even without frank perforation.
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Tamponade from atrial screw scratching without perforation warrants post-implant vigilance; leaves open true incidence and prevention strategies.
Screw-in atrial pacing leads are widely used. Cardiac tamponade is a complication. An 81-year-old woman with advanced atrioventricular block underwent permanent pacemaker implantation and subsequently developed cardiac tamponade. At surgery, the lead-tip screw was found penetrated through the right atrium but not through the pericardium. The source of bleeding was confirmed to scratching the inner pericardial membrane by the screw tip. Although cardiac tamponade due to perforation and leakage is known, tamponade caused by the trauma of an atrial screw on the pericardium with resultant ooze is less well described.
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Aizawa et al. (2001) studied this question.
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