Right coronary artery perforation by an active-fixation atrial pacing lead resulting in life-threatening tamponade

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• 作者：Eiichiro Nakagawa ; M.D. ; Ph.D.^a ; ^{enakagawa-circ@umin.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Yukio Abe ; M.D.^a ; Ryushi Komatsu ; M.D. ; Ph.D.^a ; Takahiko Naruko ; M.D. ; Ph.D.^a ; Akira Itoh ; M.D. ; Ph.D.^b
• 关键词：Pacemaker ; Active-fixation atrial pacing lead ; Cardiac tamponade ; Right coronary artery perforation
• 刊名：Journal of Arrhythmia
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：31
• 期：5
• 页码：313-315
• 全文大小：1921 K

文摘

Cardiac tamponade resulting from perforation of a cardiac chamber is a relatively rare complication of pacemaker implantation. We report the first case of perforation of the right coronary artery related to the implantation of a screw-in atrial pacing lead, presenting as life-threatening cardiac tamponade.

We report the case of a 72-year-old woman with complete atrioventricular block and dyspnea on exertion. A permanent pacemaker was implanted with bipolar Medtronic active-fixation leads positioned in the right atrial appendage and at the right ventricular basal septum without any difficulty. Approximately 3.5 h after the procedure, the patient complained of nausea, and the systolic blood pressure decreased to less than 60 mmHg. Echocardiography revealed a large pericardial effusion. Because the effects of pericardiocentesis lasted for less than an hour, the patient underwent a thoracotomy. After evacuation of a massive hemopericardium, bright red blood was seen gushing out from the right coronary artery, which was located on the opposite site of the right atrial appendage where a small portion of the screw tip was observed to be penetrating the atrial wall. The right coronary artery perforation was repaired using autologous pericardium-reinforced 7-0 prolene mattress sutures.

Perforation of the right coronary artery is a potential complication and should be part of the differential diagnosis of cardiac tamponade after pacemaker implantation.