Chest Pain Due to Pacemaker Lead Perforation
An 85-year-old woman presented complaining of chest pain one week after discharge from another hospital, where she had undergone the placement of a dual-chamber pacemaker to treat sick sinus syndrome. An ECG on admission revealed atrial fibrillation with ventricularly stimulated ventricular complexes and a heart rate of 72 beats per minute. There were no specific abnormalities on physical examination. A chest x-ray revealed dislocation of the ventricular lead, with its tip outside the cardiac silhouette. A clinically significant pericardial effusion was ruled out by echocardiography, and computed tomography confirmed that the lead tip lay in the mediastinum (Figure). The ventricular lead was repositioned uneventfully; preparations had been made for immediate cardiac surgical intervention as needed, but this was, fortunately, unnecessary.
Dr. med. Martin Christ, Dr. med. Martin Grett, Prof. Dr. med. Hans-Joachim Trappe, Medizinische Klinik II, Schwerpunkt Kardiologie und Angiologie, Marien Hospital Herne, Ruhr-Universität Bochum, firstname.lastname@example.org
Conflict of interest statement: The authors state that they have no conflict of interest.
Cite this as: Christ M, Grett M, Trappe HJ: Chest pain due to pacemaker lead perforation. Dtsch Arztebl Int 2018; 115: 242. DOI: 10.3238/arztebl.2018.0242
Translated from the original German by Ethan Taub, M.D.