# Right Atrial Perforation With Pericardial Effusion and Visceral Pericardial Flap Observed During Pacemaker Implantation: An Echocardiographic Case Report

## TL;DR

A rare case of right atrial perforation during pacemaker implantation was identified and managed without surgery.

## Contribution

This case report documents a rare intraoperative complication involving a visceral pericardial flap during pacemaker implantation.

## Key findings

- Echocardiography confirmed right atrial perforation and pericardial effusion during pacemaker implantation.
- The patient was successfully managed conservatively without surgical intervention.
- The case highlights the importance of immediate imaging and hemodynamic assessment during such events.

## Abstract

Pacemaker implantation is a common procedure for the treatment of symptomatic bradyarrhythmias. Although generally safe, it can be associated with serious complications, such as cardiac perforation or pericardial effusion. However, right atrial wall perforation, accompanied by pericardial effusion and visualization of a visceral pericardial flap during the procedure, is an extremely rare and scarcely documented event.

We report the case of a 92-year-old woman with sinus node dysfunction who developed acute hypotension during dual-chamber pacemaker implantation. Echocardiography revealed findings consistent with right atrial perforation and pericardial effusion, which were confirmed by non-contrast computed tomography. The patient evolved favorably under conservative, non-surgical management. This case illustrates an uncommon complication of pacemaker implantation and underscores the importance of immediate hemodynamic and imaging assessment during acute intraoperative events.