Huang Ying-Ying, Chen Pei-Yun, Lin Yen-Nien, Lo Chyi
Department of Cardiovascular Medicine, China Medical University Hospital, Taichung City, Taiwan.
Department of Nursing, Jen-Teh Junior College of Medicine Nursing and Management, Miaoli County, Taiwan.
Am J Case Rep. 2024 Dec 14;25:e945008. doi: 10.12659/AJCR.945008.
BACKGROUND Pacemaker implantation serves as a prevalent therapeutic approach for bradycardia or atrioventricular blocks associated with syncope. While generally regarded as safe, this procedure is not devoid of rare yet severe complications. Examples include lead-induced cardiac perforation resulting in pneumothorax or pericardial effusion, which pose life-threatening risks. CASE REPORT This article presents a case study detailing the experience of an 87-year-old patient diagnosed with complete atrioventricular block who underwent permanent pacemaker implantation, complicated by lead displacement and cardiac perforation. Despite the absence of typical post-implantation symptoms, such as backache, chest tightness, shortness of breath, and drops in blood pressure, the electrocardiogram (ECG) revealed a right bundle-branch block pattern. Additionally, bradycardia and occasional pacemaker capture failure were observed the day following pacemaker implantation. Subsequent X-ray and computer tomography examinations confirmed displacement of the ventricular lead and the presence of cardiac perforation and left pneumothorax. Following emergent thoracic drainage and repositioning of the right ventricular lead, the patient was discharged without further complications. CONCLUSIONS This case highlights the importance of thorough post-implantation monitoring, even in the absence of typical symptoms. Early detection through electrocardiogram, X-ray, and CT can facilitate timely intervention, as demonstrated by the successful treatment and discharge of the patient following emergent thoracic drainage and pacemaker lead repositioning.
背景 起搏器植入是治疗与晕厥相关的心动过缓或房室传导阻滞的一种常用方法。虽然一般认为该手术是安全的，但并非没有罕见但严重的并发症。例如，导线导致的心脏穿孔可导致气胸或心包积液，带来危及生命的风险。病例报告 本文介绍了一个病例研究，详细描述了一名87岁被诊断为完全性房室传导阻滞的患者接受永久性起搏器植入手术的经历，该手术并发导线移位和心脏穿孔。尽管没有出现典型的植入后症状，如背痛、胸闷、呼吸急促和血压下降，但心电图显示为右束支传导阻滞模式。此外，在起搏器植入后的第二天观察到心动过缓和偶尔的起搏器夺获失败。随后的X线和计算机断层扫描检查证实了心室导线移位以及心脏穿孔和左侧气胸的存在。在紧急进行胸腔引流并重新定位右心室导线后，患者出院，未出现进一步并发症。结论 本病例强调了即使在没有典型症状的情况下，进行全面植入后监测的重要性。通过心电图、X线和CT早期发现可促进及时干预，紧急胸腔引流和起搏器导线重新定位后患者成功治疗并出院就证明了这一点。
