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CASE REPORT
Year : 2017  |  Volume : 7  |  Issue : 1  |  Page : 65-68

Delayed pacemaker lead perforations: Why unusual presentations should prompt an early multidisciplinary team approach


Department of Cardiothoracic Surgery, Summa Health System, Summa Akron City Hospital, Akron, Ohio, USA

Correspondence Address:
Michael S Firstenberg
Department of Surgery (Cardiothoracic), Summa Akron City Hospital, 75, Arch Street, Suite 407, Akron, Ohio 44309
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.201951

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Our first case is an 84-year-old female diagnosed with sick sinus syndrome. She underwent implantation of dual chamber permanent pacemaker without complications. On the 8th day status-postimplantation, she returned to the emergency department (ED) with moderately severe left anterior chest pain and significant ecchymosis. She was given an initial diagnosis of shingles and discharged. Two days later, she returned to the ED with increasing chest pain, dyspnea, nausea, and vomiting. Lead migration and cardiac perforation was confirmed by chest X-ray and computed tomography (CT), respectively. She was taken to the operating room (OR) for lead repositioning, and she was discharged the next day. Our second case is a 64-year-old female with a diagnosis of 2:1 high-grade third-degree atrioventricular block. A dual chamber permanent pacemaker system was implanted without initial complication. Five days after implantation, she presented to the ED following an episode of syncope due to hypotension (67/46), shortness of breath, left flank pain, and fatigue. The initial diagnosis was sepsis. A chest CT was obtained, noting lead perforation and hemothorax. The patient was taken to the OR for lead repositioning.


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