Key result
A 76-year-old woman developed a right ventricular perforation by a pacemaker lead five months after implantation, which was discovered during aortic valve replacement surgery.
Case Report (n=1)
A dramatic increase in pacemaker threshold magnitude can be a sign of lead perforation, a serious complication requiring prompt identification and management.
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Late perforation may be asymptomatic and found incidentally; this case extends sparse reports of delayed lead complications but leaves open optimal surveillance needs.
We herein report the case of a 76-year-old woman who underwent pacemaker implantation due to sick sinus syndrome five months prior to admission. The threshold magnitude of her pacemaker lead continued to increase, and, four months later, she developed severe aortic valve stenosis. Therefore, aortic valve replacement was performed via median sternotomy. The operative findings showed that the pacemaker lead had perforated the myocardium, reaching the pericardium (Picture 1, 2). We removed the perforated lead surgically and implanted a new lead in the right ventricular epicardium. In general, cardiac perforation is one of the most serious complications of pacemaker implanta-tion (1, 2). Physicians must pay careful attention when the threshold magnitude of a pacemaker changes dramatically.
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Katoh et al. (2014) conducted a case report in Pacemaker lead perforation (n=1). Pacemaker implantation was evaluated. A 76-year-old woman developed a right ventricular perforation by a pacemaker lead five months after implantation, which was discovered during aortic valve replacement surgery.
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