Aortic perforation following percutaneous coronary intervention in a patient with permanent pacemaker: a case report

Background: Lead perforation is an uncommon complication of permanent pacemaker (PPM) implantation, occurring in 0.1-0.8% of cases (1). Aortic perforation caused by a pacing lead is rare and has been described only in case reports. Case summary: A 70-year-old Chinese man with a medical history of diabetes mellitus and hypertension presented to the hospital with intermittent chest pain of 3 weeks duration. He was diagnosed with chronic coronary syndrome and underwent percutaneous coronary intervention (PCI) to left anterior descending artery. Two days after post-PCI, he developed shock due to cardiac tamponade. A repeat angiogram was unremarkable; however, during thoracotomy, the right atrial pacing lead of a dual-chamber pacemaker, implanted 6 weeks previously for complete heart block, was found to have perforated the aorta. The patient was discharged in stable condition 20 days after successful repair of the aortic perforation. Discussion: Careful analysis of non-specific chest pain is crucial. This case highlights the importance of considering rare sequelae after multiple cardiac procedures, such as PPM and PCI. This case demonstrates the risk of aortic injury from extra-support guides during PCI, particularly near right atrial pacing leads.