Atrial Pseudoaneurysm Secondary to Pacemaker Implant Complicated with Device Infection and Pericardial Abscess Formation: A Case Report

Introduction/Background A cardiovascular implantable electronic device infection (CIEDI) is a rare but serious complication, often difficult to diagnose. We present a unique case of CIEDI involving a long-standing right atrial pseudoaneurysm with pericardial abscess related to an old pacemaker system. Case Presentation A 51-year-old woman with a dual-chamber pacemaker presented with prolonged fever and lead dysfunction. Multimodal imaging revealed lead perforation into the pericardial sac, resulting in an abscess. A hybrid approach combining open surgery, percutaneous extraction, and targeted antibiotic therapy led to full recovery. Conclusion Accurate diagnosis through advanced imaging and multidisciplinary care is essential for the management of complex CIEDI and to improve outcomes.