Pericardial tamponade due to perforation with a permanent endocardial pacing catheter.

A case is presented in which shock developed suddenly during implantation of a permanent pacemaker. The cause proved to be pericardial tamponade secondary to catheter perforation. Analysis of this case and the 6 similar cases reported in the literature reveals that although perforation occurs not infrequently from immediately to many months after implantation, tamponade is quite rare and is invariably closely related temporally to catheter manipulation. Tamponade has occurred with different catheter sizes and makes. It is more likely related to local myocardial factors than to faulty technique. Closed pericardiocentesis is generally unsuccessful in relieving the tamponade, and prompt open drainage through the subxiphoid approach is recommended.