Uncomplicated Right Ventricular Lead Perforation Diagnosed with Computed Tomography after Permanent Pacemaker Implantation

Korean J Med > Volume 71(1); 2006 > Article

Review

The Korean Journal of Medicine 2006;71(1):292-292.

Uncomplicated Right Ventricular Lead Perforation Diagnosed with Computed Tomography after Permanent Pacemaker Implantation

, ,

1Department of Internal Medicine, Hanyang University College of Medicine, Seoul; 2Department of Life Science, Postech Biotech Center, Pohang University of Science and Technology, Pohang, Korea

Uncomplicated Right Ventricular Lead Perforation Diagnosed with Computed Tomography after Permanent Pacemaker Implantation

Yong-Seok Kim, ,

Abstract

A 64-year-old woman presented to the emergency room with left chest pain which was aggravated with left lateral decubitus position. Four days ago, she underwent implantation of a single chamber permanent pacemaker (St. Jude Medical, Regency SC+) due to sick sinus syndrome. A passive fixation lead (St. Jude Medical, 1646T/58) was implanted in the right ventricle (RV). At the time of implantation, the lead was well-positioned in the RV apex and all lead parameters were within normal limits. Chest X-ray before her discharge showed no position change of the ventricular lead, and the patient discharged without problem. The electrocardiogram and pacemaker analysis revealed sensing and capture failure. Chest X-ray findings were not remarkable. Transthoracic echocardiography excluded pericardial effusion but could not confirm the ventricular lead tip position. Cardiac CT scan revealed the abnormal lead tip position in the anterior chest wall and confirmed the diagnosis of pacemaker lead perforation (panel A). The displaced lead was removed by open chest surgery. Surgical exploration showed that the pacemaker lead had perforated the RV and the parietal pericardium without hemopericardium (panel B). The perforated myocardium was repaired, and a new epicardial pacemaker lead was successfully implanted. This case illustrates an unusual feature of pacemaker lead perforation without hemopericardium, in which cardiac CT scan seems to be more informative than transthoracic echocardiography for confirmative diagnosis.