A case of cardiac tamponade due to coronary artery injury caused by atrial screw-in lead.
J Cardiol Cases
; 23(2): 80-82, 2021 Feb.
Article
em En
| MEDLINE
| ID: mdl-33520029
ABSTRACT
A 74-year-old man who had a history of paroxysmal atrial fibrillation, visited the emergency department because of syncope. An electrocardiogram showed atrial fibrillation with slow ventricular response and long pauses. A permanent pacemaker was implanted under oral anticoagulation. Two screw-in leads were positioned at the right atrial appendage and the right ventricular apex. Seven hours after the implantation, he collapsed with hypotension due to cardiac tamponade. Vital signs improved after urgent pericardial drainage, but blood was continuously drained from the pericardial catheter. Due to uncontrollable cardiac tamponade, surgical repair was indicated. We found neither of the leads perforated the myocardium, but there was intermittent bleeding from a pin hole injury in the atrial wall site of the right coronary artery. Redness was observed in the right atrial appendage, but there was no bleeding point. We supposed that the screw tip of the atrial lead might have perforated the atrial appendage,ãbut was retracted spontaneously afterwards. The pin hole was closed with a patch and the postoperative course was uneventful. This is a rare case of cardiac tamponade due to the injury of the coronary artery by a screw-in lead positioned at the right atrial appendage. <Learning objectives:
Pacemaker implantation can cause cardiac tamponade due to coronary artery perforation. Right coronary artery perforation due to screwed-in atrial lead can be a cause of cardiac tamponade after pacemaker implantation, especially if proximal portion of right coronary artery meanders close to atrial appendage.>.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Idioma:
En
Revista:
J Cardiol Cases
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Japão