title: [Cardiac perforation following pacemaker implantation - a case series from Iceland].
abstract: Perforation of the heart is a serious complication following pacemaker implantation that can cause life threatening bleeding and cardiac tamponade. Here we describe five cases that were diagnosed in Iceland during a four year period.
  
  
  
  This population-based case series includes five patients diagnosed with cardiac perforation following pacemaker insertion at Landspítali and Akureyri Hospital from January 1, 2007 to December 31, 2010. The mode of detection, treatment given and outcome were studied.
  
  
  
  Altogether five patients (mean age 71 years, three females) were diagnosed with cardiac perforation in Iceland during the study period, one in 2008 and four in 2009. Chest pain was the most common presenting symptom (n=4) and no patient had acute cardiac tamponade. In all five cases the diagnosis was obtained with computed tomography scan or echocardiography. No perforation was detected intraoperatively but four of the cases were diagnosed within three weeks of the operation. Three patients were treated with surgical evacuation of blood via sternotomy and suture of the perforation. In the other two cases the pacemaker leads were removed in the operating room with trans-oesophageal echocardiographic guidance. Four patients survived the treatment and were discharged but one died of pneumonia in the intensive care unit.
  
  
  
  Cardiac perforation is a serious complication and should be kept in mind in patients with chest pain following pacemaker insertion.
authors.affiliation: Department of Cardiothoracic Surgery, National University Hospital of Iceland, Reykjavik.
authors.forename: Ingvar Th
authors.initials: IT
authors.lastname: Sverrisson
authors.forename: Jón
authors.initials: J
authors.lastname: Hognason
authors.forename: Halla
authors.initials: H
authors.lastname: Vidardottir
authors.forename: Gizur
authors.initials: G
authors.lastname: Gottskalksson
authors.forename: Gunnar Thór
authors.initials: GT
authors.lastname: Gunnarsson
authors.forename: Jón Thór
authors.initials: JT
authors.lastname: Sverrisson
authors.forename: Tomas
authors.initials: T
authors.lastname: Gudbjartsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002637:Chest Pain / Q000209:etiology; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007055:Iceland; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011014:Pneumonia / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D056346:Sternotomy; D013536:Suture Techniques; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome