Objectives: Pacemaker incidence and prevalence are on the rise over the last decade especially in the elderly population. Though complications are rare, most reported literature is about early pacemaker complication. Late complications are also reported, but mostly regarding malfunction or infections. Very few case reports and series report late cardiac perforations which could be catastrophic. We report a case of late cardiac perforation diagnosed and treated in our institution to raise the awareness of this very serious complication.
Case summary: A 65-year-old male who had a single chamber right ventricular pacemaker inserted two months earlier for sick sinus syndrome, presented to the hospital with complaint of shortness of breath. Chest X-ray (CXR) revealed new large left sided pleural effusions. Computed tomography (CT) scan of the chest suggested migration of the pacemaker lead with perforation of the right ventricle associated with hemothorax with no pericardial effusions. A bedside echo confirmed the perforation and showed minimal pericardial effusions with no cardiac tamponade. Clinically patient was hemodynamically stable. He underwent open surgical repair and placement of epicardial pacer leads.
Conclusions: Clinicians should be aware of the early and late complications of pacemaker insertions and how to diagnose and treat them appropriately to avoid unnecessary morbidity or mortality.