Key result
POCUS distinguishes true cardiac tamponade from stable hemopericardium after pacemaker lead perforation.
Why the study?
Pacemaker lead perforation can cause pericardial effusion and cardiac tamponade, but distinguishing tamponade from stable effusion using POCUS requires integration of sonographic and clinical findings.
Case Report (n=2)
Point-of-care ultrasound is essential for rapidly differentiating between stable large effusions and true tamponade physiology in patients with pacemaker lead perforation.
May inform urgent bedside decisions in pacemaker-related effusions; leaves open need for prospective validation before broader adoption.
Pacemaker lead perforation is a recognised cause of iatrogenic pericardial effusion and may progress to life-threatening cardiac tamponade. Point-of-care ultrasound (POCUS) is essential for rapid bedside evaluation, yet the distinction between a large but haemodynamically stable effusion and true tamponade physiology requires integration of sonographic findings and clinical presentation. We present two cases of pacemaker-associated haemopericardium with markedly different physiological consequences: one showed haemodynamic instability with clear tamponade and the other initially stable without tamponade despite a massive effusion. This case pair demonstrates how POCUS can be used to differentiate these states and underscores the importance of evaluating both the heart and the patient as a whole.
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Chan et al. (2026) conducted a case report in Pacemaker-associated haemopericardium (pacemaker lead perforation) (n=2). Point-of-care ultrasound (POCUS) was evaluated. Point-of-care ultrasound successfully differentiated between pacemaker-associated haemopericardium with true cardiac tamponade physiology and a massive but haemodynamically stable effusion.
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