Complete atrial screw lead penetration and contralateral pneumothorax post-pacemaker implantation

Q4 Medicine Journal of Cardiology Cases Pub Date : 2025-01-01 Epub Date: 2024-09-23 DOI:10.1016/j.jccase.2024.09.002

Satoko Shiomi MD, Michifumi Tokuda MD, PhD, Hidenori Sato MD, PhD, Kenichi Tokutake MD, PhD, Seigo Yamashita MD, PhD, Michihiro Yoshimura MD, PhD, FJCC, Teiichi Yamane MD, PhD

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Abstract

There are some reports of atrial screw-in lead perforation, but the entire lead body is rarely exposed outside the right atrium at an early stage of the procedure. A man in his 80s had undergone catheter ablation for atrial fibrillation (AF) and had recurrent AF and tachycardia-bradycardia syndrome with 8.8 s of sinus arrest, which caused presyncope. The day after the dual-chamber pacemaker was implanted, atrial screw-in lead perforation caused an elevated threshold, a right pneumothorax, bloody pleural effusion, and pneumomediastinum. A small right thoracotomy with thoracoscopy was performed. The lead that completely penetrated the right atrial appendage and was exposed was safely retracted into the heart and removed thoracoscopically. Early surgery is essential when complete lead perforation with elevated threshold is suspected.

Learning objectives

1.
Perforation of the right atrium by the screw-in lead causes contralateral pneumothorax and chest hemorrhage.
2.
Elevated lead threshold suggests lead perforation outside the myocardium.
3.
Treatment was possible with a small right thoracotomy combined with thoracoscopy.

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心脏起搏器植入术后完全性心房螺钉穿刺及对侧气胸。

有一些关于心房螺旋导联穿孔的报道，但是在手术的早期，整个导联体很少暴露在右心房外。一名80多岁男性因房颤（AF）行导管消融治疗，复发性房颤和心动过速-心动过缓综合征，伴有8.8 s的窦性停搏，引起晕厥前期。双室起搏器植入后的第二天，心房螺旋导联穿孔导致阈值升高、右侧气胸、胸膜积血和纵隔气肿。在胸腔镜下行右小开胸术。完全穿透右心耳并暴露的导联安全缩回心脏并在胸腔镜下取出。当怀疑有阈值升高的完全性铅穿孔时，早期手术是必要的。学习目标：右心房被螺钉插入导致对侧气胸和胸出血。铅阈值升高提示心肌外铅穿孔。治疗是可行的小右开胸联合胸腔镜。

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