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Case Reports in Cardiology
Volume 2017, Article ID 1264734, 4 pages
https://doi.org/10.1155/2017/1264734
Case Report

Subacute Right Ventricular Perforation by Pacemaker Lead Causing Left-Sided Hemothorax and Epicardial Hematoma

1Internal Medicine Department, Wayne State University/Detroit Medical Center, Detroit, MI, USA
2Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, USA

Correspondence should be addressed to Abdelrahman Ahmed; ude.enyaw.dem@demhama

Received 1 April 2017; Revised 18 August 2017; Accepted 9 October 2017; Published 16 November 2017

Academic Editor: Assad Movahed

Copyright © 2017 Abdelrahman Ahmed et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of right ventricular wall perforation by a pacemaker lead in a 78-year-old female 18 days after a permanent pacemaker insertion. This injury necessitated explant of the perforating lead and implantation of a new one with surgical backup. We review the literature and discuss the possible risk and protective factors including lead models that were associated with higher incidence of perforation. We review the traditional pacing parameters and their lack of reliability to diagnose perforation and the need for low threshold to utilize imaging in appropriate clinical scenarios. The authors believe this case is of educational value to all health care professionals, especially emergency medicine and internal medicine residents, who routinely see patients with pacemakers complaining of chest pain, shortness of breath, or dizziness.