Published in:
Open Access 01-12-2017 | Case image in cardiovascular ultrasound
Subacute right ventricular pacemaker lead perforation: evaluation by echocardiography and cardiac CT
Published in: Journal of Echocardiography | Issue 4/2017
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A 77-year-old female patient with a history of chronic obstructive pulmonary disease and paroxysmal atrial fibrillation presented to our emergency department with collapse and was diagnosed with sick sinus syndrome. Before pacemaker implantation, echocardiography showed normal dimensions of both atria and ventricles and normal systolic left and right ventricle (RV) function. A DDD-R pacemaker was successfully implanted using active-fixation leads without any acute complications. The day after implantation, sensing and pacing parameters were normal and unchanged. Chest radiography then showed a normal position of both leads (Fig. 1a, b). Subsequently, the patient was discharged the same day in good clinical health.
Fig. 1
a Chest radiography [postero-anterior (PA) view] the day after pacemaker implantation. b Lateral view. c Chest radiography (PA view) upon presentation to the emergency room showing an altered position of the RV lead (arrowhead). d Lateral view (arrowhead shows altered lead position). e Transthoracic echocardiography (subcostal view) suggesting myocardial perforation of the RV lead through the RV apex (arrowhead), but without pericardial effusion, raising doubt as to whether the lead tip lay in the pericardial space. See also online video. LA left atrium, LV left ventricle, RA right atrium, RV right ventricle. f Thoracic computed tomography (coronal view) with lead tip clearly visible through the myocardium (arrowhead). RV right ventricle. g Thoracic computed tomography (sagittal view) showing lead tip running through myocardium (arrowhead). RV right ventricle
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