Perforation of the Interventricular Septum by a Temporary Transvenous Pacing Lead Detected by Cardiac Point of Care Ultrasound (POCUS)

TL;DR

A temporary pacemaker lead accidentally pierced the heart wall, but was safely repositioned using ultrasound, highlighting the importance of this technique in monitoring such devices.

Contribution

Demonstrates the utility of cardiac POCUS in detecting and managing complications from temporary pacemaker lead placement.

Findings

POCUS identified a pacing lead perforating the heart's septum three days after insertion.

Prompt repositioning of the lead using POCUS prevented further complications.

Cardiac POCUS is recommended for early detection of TTP-related complications.

Abstract

Several complications can arise during or shortly after the placement of a temporary transvenous pacemaker (TTP), some of which can be potentially devastating. A TTP was successfully placed under the guidance of point of care ultrasound (POCUS) and intracavitary electrocardiogram (ECG) in a middle-aged woman with symptomatic complete atrioventricular block. Three days post-insertion, pacemaker malfunction was observed along with the migration of the pacing lead to the left ventricular apex on cardiac POCUS. The lead was promptly repositioned, and no complications were noted on subsequent cardiac POCUS examinations. To prevent complications and aid early detection of complications associated with TTPs, cardiac POCUS should be strongly considered.

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