Temporary Transvenous Pacemaker Lead-Induced Cardiac Perforation Incidentally Detected by Right Ventriculography Prior to Leadless Pacemaker Implantation

TL;DR

A temporary pacemaker lead caused a heart wall perforation, which was found during a heart imaging test before implanting a leadless pacemaker.

Contribution

Demonstrates the importance of right ventriculography in detecting lead-induced cardiac perforation before lead removal.

Findings

Right ventriculography revealed a perforation caused by a temporary pacemaker lead.

The lead was safely removed after preparing for pericardiocentesis.

RVG proved useful in identifying complications before leadless pacemaker implantation.

Abstract

Temporary transvenous pacemakers (TTPs) are lifesaving device in patients with hemodynamically unstable bradycardia, but are associated with serious complications, including right ventricular (RV) perforation. We present a case of a 91-year-old woman with complete atrioventricular block and bradycardia who received a TTP. After that, she underwent leadless pacemaker implantation. Preprocedural right ventriculography (RVG) revealed an incidental RV wall perforation by the TTP lead. After preparing for pericardiocentesis, the lead was safely extracted without complications. This case highlights the utility of RVG in detecting lead-related complications, where it is necessary to prepare pericardiocentesis prior to lead removal.

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