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PICTURES IN CLINICAL MEDICINE
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Pacemaker Lead Perforation through the Right Ventricle Masanori Katoh and Yukiharu Sugimura Key words: pacemaker lead, right ventricle, perforation, pacemaker implantation (Intern Med 53: 2831, 2014) (DOI: 10.2169/internalmedicine.53.3033)
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We herein report the case of a 76-year-old woman who underwent pacemaker implantation due to sick sinus syndrome five months prior to admission. The threshold magnitude of her pacemaker lead continued to increase, and, four months later, she developed severe aortic valve stenosis. Therefore, aortic valve replacement was performed via median sternotomy. The operative findings showed that the pacemaker lead had perforated the myocardium, reaching the pericardium (Picture 1, 2). We removed the perforated lead surgically and implanted a new lead in the right ventricular epicardium. In general, cardiac perforation is one of the most serious complications of pacemaker implanta-
tion (1, 2). Physicians must pay careful attention when the threshold magnitude of a pacemaker changes dramatically. The authors state that they have no Conflict of Interest (COI).
References 1. Haq SA, Heitner JF, Lee L, Kassotis JT. Late presentation of a lead perforation as a complication of permanent pacemaker insertion. Angiology 59: 619-621, 2008. 2. Koyama S, Itatani K, Kyo S, et al. Subacute presentation of right ventricular perforation after pacemaker implantation. Ann Thorac Cardiovasc Surg 19: 73-75, 2013.
Department of Cardiovascular Surgery, Fuji Heavy Industries Health Insurance Society Ota Memorial Hospital, Japan Received for publication April 6, 2014; Accepted for publication June 1, 2014 Correspondence to Dr. Yukiharu Sugimura,
[email protected] Ⓒ 2014 The Japanese Society of Internal Medicine Journal Website: http://www.naika.or.jp/imonline/index.html
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