Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Delayed cardiac perforation due to migrating pacemaker lead

Anastasia Oikonomou, Soultana Foutzitzi and Panos Prassopoulos
CMAJ June 15, 2010 182 (9) E379; DOI: https://doi.org/10.1503/cmaj.091352
Anastasia Oikonomou
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Soultana Foutzitzi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Panos Prassopoulos
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

An 84-year-old woman with complete atrioventricular block underwent implantation of a dual-chamber pacemaker with passive fixation leads. The settings of the pacemaker were normal, and chest radiographs 2 and 24 hours after implantation confirmed appropriate positioning of the two leads. At one-month follow-up, the patient complained of chest pain and breathlessness that had started one week earlier and had progressively worsened. A chest radiograph showed the pacemaker lead projecting over the left hemidiaphragm. A computed tomography scan showed that the lead had perforated the myocardium of the right ventricular apex and the left hemidiaphragm; the tip of the lead was lodged in the left subdiaphragmatic space (Figure 1). During thoracotomy, the lead was found be moving freely in the left subdiaphragmatic space with no pericardial hemorrhage. The old lead was removed, and a new epicardial lead was positioned successfully.

Figure1
  • Download figure
  • Open in new tab
  • Download powerpoint

Figure 1: Unenhanced computed tomography of the thorax in an 84-year-old woman one month after implantation of pacemaker showing the lead (arrow) penetrating the left hemidiaphragm and the tip lodging in the subdiaphragmatic space.

Cardiac perforation is a well recognized — although infrequently reported — complication of pacemaker implantation (0.3%–1.0%). 1 It usually occurs during implantation, and is less common after 24 hours; hemopericardium may or may not occur. Chest pain or shortness of breath after insertion of a pacemaker is unusual and must be investigated promptly to exclude cardiac perforation. Delayed perforation by pacemaker leads (in this patient, one month after implantation) is uncommon. 2

Clinical predictors of cardiac perforation after pacemaker implantation are older age, use of corticosteroids, temporary pacing and active fixation leads. 3 Our patient was older, and passive fixation leads were used. Forces at the lead tip of a pacemaker are complex, vary during the cardiac cycle and may change over time. 4 If chest radiography shows that the tip appears to have migrated beyond the pericardium, a computed tomography scan should be done to confirm the diagnosis. Surgery is required to find the site of perforation and repair adjacent structures. 2 Delayed development of chest, pericarditic or pleuritic pain after implantation of a pacemaker warrants a high level of suspicion for cardiac perforation by a lead, regardless of the method used to fix the lead tips.

Footnotes

  • Previously published at www.cmaj.ca

    This article has been peer reviewed.

    Competing interests: None declared.

    Clinical images are chosen because they are particularly intriguing, classic or dramatic. Submissions of clear, appropriately labelled high-resolution images must be accompanied by a figure caption and the patient’s written consent for publication. A brief explanation (300 words maximum) of the educational significance of the images with minimal references is required.

REFERENCES

  1. 1.↵
    Akyol A, Aydin A, Erdinler I, et al. Late perforation of the heart, pericardium, and diaphragm by an active-fixation ventricular lead. Pacing Clin Electrophysiol 2005;28:350–1.
    OpenUrlCrossRefPubMed
  2. 2.↵
    Singhal S, Cooper JM, Cheung AT, et al. Rib perforation from a right ventricular pacemaker lead. Circulation 2007;115:e391–2.
    OpenUrlFREE Full Text
  3. 3.↵
    Mahapatra S, Bybee KA, Bunch TJ, et al. Incidence and predictors of cardiac perforation after permanent pacemaker placement. Heart Rhythm 2005;2:907–11.
    OpenUrlCrossRefPubMed
  4. 4.↵
    Ramirez MF, Ching CK, Ho KL, et al. “The attack of the 52 cm lead”: an unusual case of late cardiac perforation by a passive-fixation permanent pacemaker lead. Int J Cardiol 2007;115:e5–7.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 182 (9)
CMAJ
Vol. 182, Issue 9
15 Jun 2010
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Delayed cardiac perforation due to migrating pacemaker lead
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Delayed cardiac perforation due to migrating pacemaker lead
Anastasia Oikonomou, Soultana Foutzitzi, Panos Prassopoulos
CMAJ Jun 2010, 182 (9) E379; DOI: 10.1503/cmaj.091352

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Delayed cardiac perforation due to migrating pacemaker lead
Anastasia Oikonomou, Soultana Foutzitzi, Panos Prassopoulos
CMAJ Jun 2010, 182 (9) E379; DOI: 10.1503/cmaj.091352
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • REFERENCES
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • “Superscan” in diffusion-weighted imaging with background body suppression magnetic resonance imaging
  • Using intranasal corticosteroids
  • Langerhans cell histiocytosis in a 5-month-old baby
Show more Practice

Similar Articles

Collections

  • Sections
    • Clinical Images
  • Topics
    • Cardiovascular medicine

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire