Key result
Pacemaker implant results in subacute RV lead perforation and large haemothorax requiring cardiothoracic surgery.
Case Report (n=1)
This case highlights the rare but severe complication of pacemaker lead perforation causing intercostal artery injury and haemothorax, emphasizing the need for early recognition and surgical intervention.
Prompts vigilance for intercostal artery injury in post-implant haemothorax; this case leaves open optimal prevention and incidence.
A woman in her 80s experienced a life-threatening complication of pacemaker implant consisting of subacute right ventricular lead perforation causing iatrogenic injury to an intercostal artery, resulting in a large haemothorax. A CT scan confirmed active bleeding from the fourth intercostal artery. The patient underwent cardiothoracic surgery via a median sternotomy approach, during which the source of the bleeding was sealed, a new epicardial lead was positioned, and the original lead was extracted. This case emphasises the potentially severe consequences of pacemaker lead perforation and secondary injury to adjacent structures. It underscores the importance of early recognition and timely intervention, preferably in a tertiary specialist unit equipped for cardiothoracic surgery and confirms the value of pacemaker interrogation and CT scans for diagnosis.
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Björkenheim et al. (2024) conducted a case report in Right ventricular lead perforation and haemothorax after pacemaker implant (n=1). Pacemaker implant was evaluated on Right ventricular lead perforation causing haemothorax. Pacemaker implant resulted in a subacute right ventricular lead perforation and intercostal artery injury causing a large haemothorax, which was successfully managed with cardiothoracic surgery.
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