Perforation of the Right Atrium With the Development of Right-Sided Pneumothorax and Pneumopericardium in a Patient With an Implanted Dual-Chamber Pacemaker

 Development of pneumothorax after pacemaker implantation is an uncommon complication. Pneumothorax, contralateral to venous access site, due to atrial lead perforation is a more rare complication. The most frequently reported predictors of lead perforation are active fixation leads, low body mass index, older age, female gender and concomitant anticoagulation therapy. We described a clinical case of a 69-year-old patient who had undergone radiofrequency ablation of atrial fibrillation several years earlier. Several years later, the patient developed sick sinus syndrome (chronotropic incompetence) and bifascicular block, as a result of which he was implanted with a dual-chamber pacemaker, which was subsequently complicated by perforation of the right atrial appendage with damage to the middle lobe of the right lung with the development of pneumothorax and pneumopericardium. Described cases illustrates that if right pneumothorax symptoms occur in a patient where the device was placed from a left subclavian approach, perforation of the atrial appendage should be excluded. By far the preferred method of diagnosing this complication today is chest CT scan.