title: Right coronary artery perforation by an active-fixation atrial pacing lead resulting in life-threatening tamponade.
abstract: 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.
authors.affiliation: Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Nakagawa
authors.affiliation: Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Abe
authors.affiliation: Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
authors.forename: Ryushi
authors.initials: R
authors.lastname: Komatsu
authors.affiliation: Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Naruko
authors.affiliation: Department of Cardiology, HITO Hospital, 788-1 Kamibun-cho, Shikokuchuo City, Ehime Prefecture 799-0121, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Itoh
keywords: Active-fixation atrial pacing lead; Cardiac tamponade; Pacemaker; Right coronary artery perforation