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Case Reports
. 2024 Feb 7;17(2):e258314.
doi: 10.1136/bcr-2023-258314.

Right ventricular lead perforation with iatrogenic injury to an intercostal artery causing haemothorax after pacemaker implant

Anna Björkenheim  1 , Torbjörn Kalm  2 , Mats Lidén  3 , Mårten Vidlund  4
Affiliations
Case Reports

Right ventricular lead perforation with iatrogenic injury to an intercostal artery causing haemothorax after pacemaker implant

Anna Björkenheim et al. BMJ Case Rep. .

Abstract

A woman in her 80s experienced a life-threatening complication of pacemaker implant consisting of subacute right ventricular lead perforation causing iatrogenic injury to an intercostal artery, resulting in a large haemothorax. A CT scan confirmed active bleeding from the fourth intercostal artery. The patient underwent cardiothoracic surgery via a median sternotomy approach, during which the source of the bleeding was sealed, a new epicardial lead was positioned, and the original lead was extracted. This case emphasises the potentially severe consequences of pacemaker lead perforation and secondary injury to adjacent structures. It underscores the importance of early recognition and timely intervention, preferably in a tertiary specialist unit equipped for cardiothoracic surgery and confirms the value of pacemaker interrogation and CT scans for diagnosis.

Keywords: Cardiothoracic surgery; Pacing and electrophysiology; Radiology (diagnostics).

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Multiplanar reformations of arterial phase CT imaging of the thorax in sagittal (A), axial (B), and coronal (C) views, showing an extensive haemothorax. Blue arrow: extravasation of contrast medium from the intercostal artery (the artery itself is not visible). Orange arrow: the perforating ventricular electrode pointing towards the intercostal artery. Green arrow: thoracic drainage.The asterisk symbol in Figure 1 denotes the presence of a "Very large hemothorax" within the illustration for reference and emphasis.
See this image and copyright information in PMC

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