Cardiac Perforation by Permanent Pacemaker Lead, One Year after Implantation — An Unusual Occurrence and Its Management

ABSTRACT

Delayed Cardiac Perforation by Permanent Pacemaker lead beyond one year of implantation is rare. It is also rarer in passive fixation lead, compared to active fixation lead. There is no Universal consensus regarding management of such cases with percutaneous versus surgical removal of the lead followed by re-implantation. Here we report a case of Right Ventricular (RV) perforation by a passive fixation permanent lead, in an 81-year-old lady, 14 months after implantation, who presented with Pacemaker capture failure but in hemodynamically stable condition. Pacemaker lead had migrated up to the Lower Lobe of Left Lung, Perforating Right Ventricle, pericardium and Left Pleura. We managed this case with open lead removal under direct vision by Lower Median Sternotomy, followed by implantation of an Epicardial Lead and Pacemaker