A 61-Year-Old Man with Perforation of the Left Ventricle and Pericardium 3 Days After Insertion of a Cardiac Pacemaker Lead

BACKGROUND The use of implantable cardiac devices, including permanent pacemakers, has become routine, and reported complications are rare. However, in some cases, a cardiac pacemaker lead can perforate the ventricular or atrial wall. However, patients can present with nonspecific and heterogeneous clinical manifestations, leading to potential delays in diagnosis. We present a case of a 61-year-old man with perforation of the left ventricle and pericardium diagnosed 3 days after the insertion of a cardiac pacemaker lead. CASE REPORT A 61-year-old man with symptomatic second-degree type II sinoatrial block underwent uneventful dual-chamber permanent pacemaker implantation. On the evening of the third day following the pacemaker implantation procedure, the patient presented with persistent chest pain and was admitted to the hospital. Emergency chest computed tomography demonstrated that the right ventricular pacemaker lead had penetrated the left ventricle and pericardium. The patient underwent surgery on the fourth day of admission, and the pacing lead was secured to the left ventricular myocardium via a small incision in the left intercostal space. The surgical procedure was completed successfully, and the patient was discharged on the third postoperative day, without any complications. CONCLUSIONS Cardiac perforation due to the lead is a rare but potentially fatal complication of pacemaker implantation. We present a patient who presented with a left ventricular and pericardium perforation 3 days after pacemaker implantation. This clinical case underscores the necessity for screening for perforation in patients treated with cardiac implantable electronic devices prior to discharge.