Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Am J Emerg Med. 2022 Mar;53:281.e1-281.e3. doi: 10.1016/j.ajem.2021.08.081. Epub 2021 Sep 4.
Permanent pacemaker (PPM) insertion is widely used to treat cardiac rhythm disorders; approximately 600,000 pacemakers are implanted annually in the US. Almost 9% of patients who receive a permanent pacemaker, however, experience a variety of medical complications such as infections, battery problems, programming issues, lead migration, or lead fracture. Moreover 1-2% of these patients will encounter severe lead-related problems within 30 days of their pacemaker insertion. In this report, we focus on an uncommon but serious complication of PPM insertion: right ventricular lead perforation leading to a pericardial effusion. Although lead perforation is a relatively rare occurrence, this event can be life-threatening, and should be considered in the differential diagnosis when patients present to the emergency department (ED) with relevant symptoms and recent PPM insertion. Specifically, patients who experience complications from pacemaker insertion may present to the ED with a variety of symptoms such as chest pain, syncope, dyspnea, or even dizziness. Pacemaker complications include pneumothorax, pleural and/or pericardial effusions, and infection, placing the patient at serious risk for significant harm. The evaluation of a lead-related issue typically involves chest radiography to visualize abnormal lead placement and check for a pneumothorax or pleural effusion, and a 12‑lead electrocardiogram (ECG) to detect pacing errors. We present the case of a patient who presented to the ED three days after his pacemaker insertion with chest pain and dyspnea; he was subsequently diagnosed with a lead perforation into the pericardial space resulting in a pericardial effusion.
心脏起搏器（PPM）植入术被广泛用于治疗心律失常；在美国，每年大约有 60 万个起搏器被植入。然而，大约有 9%接受永久性起搏器的患者会出现各种医疗并发症，如感染、电池问题、编程问题、导线迁移或导线断裂。此外，这些患者中有 1-2%会在起搏器植入后 30 天内出现严重的与导线相关的问题。在本报告中，我们重点介绍起搏器植入术一种罕见但严重的并发症：右心室导线穿孔导致心包积液。虽然导线穿孔是一种相对罕见的情况，但这种情况可能危及生命，当患者出现相关症状且近期接受过起搏器植入术时，应在鉴别诊断中考虑这种情况。具体来说，因起搏器植入术出现并发症的患者可能会因胸痛、晕厥、呼吸困难甚至头晕等各种症状就诊于急诊部（ED）。起搏器并发症包括气胸、胸腔和/或心包积液以及感染，使患者面临严重的严重伤害风险。与导线相关的问题的评估通常包括胸部 X 光片以可视化异常导线位置并检查气胸或胸腔积液，以及 12 导联心电图（ECG）以检测起搏错误。我们介绍了一位患者的病例，他在起搏器植入后三天因胸痛和呼吸困难就诊于 ED；随后被诊断为导线穿孔进入心包腔导致心包积液。
