Internal jugular vein perforation due to blind temporary pacing lead insertion: Pitfall of a blind procedure

Temporary pacing lead is placed through the internal jugular, subclavian or femoral vein under fluoroscopic, echocardiographic, or electrocardiographic guidance. However, in most of the developing world, this procedure is done without fluoroscopic guidance. Blind procedures are known to be associated with more complications as compared to guided procedures. Here, we report a case of the right internal jugular vein perforation while placing the temporary pacing lead in an 80-year-old male patient who had permanent pacemaker implantation done 10 years back and had developed right subclavian and brachiocephalic vein stenosis. Clinicians need to be aware of this rare complication and preferably do these procedures under fluoroscopic guidance and avoid an overzealous approach if the pacing lead does not pass through easily. Patients who had undergone any procedure through their central venous system, especially with retained catheters and pacing leads in situ in the past should undergo a venogram before planning any reintervention from the ipsilateral side to avoid such complications.