Right Ventricular Perforation after Pacemaker Implantation in an Elderly Woman: A Case Report

Background: Cardiac pacing is a proven and effective treatment used worldwide with a low incidence of complications depending on the patient group. Late lead perforation is a rare complication without a standard treatment. Case summary: We report a case of a 98-year old woman submitted to pacemaker implantation due to symptomatic second-degree atrio-ventricular block. After two days she returned to the hospital with thoracic pain and was diagnosed with RV (right ventricular) lead perforation. She was submitted to cardiac surgery with lead extraction and RV repair. Discussion: There are two major types of complications after pacemaker implantation, mechanical and infection. Reported perforation rates after pacemaker implantation range from 0.1%-0.8%. While acute lead perforation is very well described, late lead perforation is only described in case reports with a low rate of tamponade or death. Management of subacute or delayed RV lead perforation is not well defined due to very limited data. Question remains on whether to extract the lead or not.