Pacemaker Lead Migration and Ventricular Perforation in a Patient Presenting with Chest Pain.

Division

East Florida

Hospital

Aventura Hospital and Medical Center

Document Type

Case Report

Publication Date

11-1-2021

Keywords

artificial pacemaker, electrocardiography, diagnostic imaging, ventricular septal rupture

Disciplines

Critical Care | Diagnosis | Internal Medicine | Surgical Procedures, Operative

Abstract

CASE PRESENTATION: We describe a middle-age male with a past medical history of second-degree atrioventricular block type II status post permanent pacemaker placement the day prior who presented to the emergency department complaining of chest pain. Electrocardiography showed a non-paced ventricular rhythm. Chest radiograph showed the ventricular pacemaker lead located distally overlying the right ventricle apical area. On further investigation, chest computed tomography showed a perforation of the ventricular wall by the pacemaker lead prompting urgent intervention by the cardiothoracic surgery team for lead replacement and right ventricular repair.

DISCUSSION: Our case illustrates the importance of timely recognition of a perforated pacemaker lead in a patient presenting with chest pain after device implantation. We additionally describe the risk factors for ventricular perforation, initial clinical presentation, and management approach.

Publisher or Conference

Clinical Practice and Cases in Emergency Medicine

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