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. 2022 Mar 2;4(5):315-317.
doi: 10.1016/j.jaccas.2022.01.012.

Lead Perforation Into the Left Internal Mammary Artery Causing Circulatory Collapse After Pacemaker Insertion

Rajesh Kumar  1 , Jathinder Kumar  1 , Ihsan Ullah  1 , Sadat Ali Edroos  2 , Sajjad Matiullah  1
Affiliations

Lead Perforation Into the Left Internal Mammary Artery Causing Circulatory Collapse After Pacemaker Insertion

Rajesh Kumar et al. JACC Case Rep. .

Abstract

A 66-year-old woman underwent a pacemaker implantation following a symptomatic pause. The pacemaker lead inadvertently punctured the ventricle during implantation, penetrating through to the left internal mammary artery, causing slow hemorrhage. There was subsequent circulatory collapse with shock. We describe this rare yet life-threatening condition. (Level of Difficulty: Intermediate.).

Keywords: CT, computed tomography; CXR, chest x-ray; LIMA, left internal mammary artery; RV, right ventricle; actively fixated pacemaker lead; bradycardia; cardiac CT; cardiac pacemaker; complications.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Internal Mammary Artery Injury Confirmation (A) Chest x-ray immediately after pacemaker insertion showing satisfactory lead positioning. (B) Chest x-ray 46 hours after pacemaker insertion showing left-sided pleural effusion. (C) Computed tomography of the thorax showed the pacemaker lead (yellow arrows) penetrating from the right ventricle to left internal mammary artery (white arrow). (D) Three-dimensional reconstruction of computed tomography confirming the lead eroding through the right ventricle (black circle) and injury with bleeding from the internal mammary artery (blue arrows). (E) Thoracotomy view confirming lead erosion perforating the myocardium and pericardium (black circle) into the internal mammary artery (yellow arrows). (F) Final chest x-ray post–resynchronization device implantation with sternotomy sutures. LV = left ventricle.
See this image and copyright information in PMC

References

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