Late Pacemaker Lead Perforation in Acute Myopericarditis: A Case Report

ABSTRACT Background Although myocarditis can be associated with ventricular wall thinning, aneurysm and free wall rupture, late pacemaker lead perforation in myopericarditis is previously unreported. Case Summary A 71-year-old male with a dual-chamber pacemaker placed 7 years prior presented with acute myopericarditis two months after atrial fibrillation ablation, left ventricular ejection fraction of 52% and small pericardial effusion. Cardiac magnetic resonance (CMR) revealed focal late gadolinium enhancement (LGE) of the basal inferolateral wall of the left ventricle. Diffuse, circumferential pericardial LGE was present around the left and right ventricle with small effusion. One month later he returned with worsening chest pain, decompensated heart failure, moderate pericardial effusion, and effusive-constrictive physiology. Echocardiography identified a new pacemaker lead perforation. Following device revision, he was discharged on colchicine, NSAIDs, and empagliflozin. On follow-up, ejection fraction normalized, constrictive physiology and cardiac inflammation resolved. Discussion Late lead perforation is a rare complication of myopericarditis and should be considered in patients who re-present with progressive pericardial effusion and decompensation after initial improvement.