Right ventricular perforation is a rare but serious complication of permanent pacemaker and implantable cardioverter-defibrillator implantation, with a reported prevalence rate of 0.1–6%. Generally, there is a high incidence of asymptomatic lead perforation with otherwise normal function. Some patients present with a stabbing chest pain and shortness of breath or pacemaker malfunction. However, in some cases, tamponade or adjacent tissue injury may be seen. The exact risk factors for lead perforation are not yet clear. Furthermore, there are many controversies in the management of lead perforation. Extraction of an asymptomatic, incidentally detected, chronically perforating lead does not seem to be necessary. Patients with symptoms or device malfunction will require treatment appropriate for their problem.

Introduction: Prognosis of the patients with beta blocker or calcium channel blocker induced AV block is not well known to date. Methods: All patients with symptomatic second-degree or third-degree atrioventricular block (AV) referred to our institution during one year were recuited prospectively and classified in two groups based on drug consumption (beta blocker/calcium channel blocker versus none). They were followed for six months and then collected data was analyzed. Results:The study included 49 patients, 28 patients (age 60.1 ± 20, 19 male) did not use any beta blocker or calcium channel blocker (No-DU group) and other 21 patients (age 73.5 ± 10.4, 7 male) receivd beta blocker, calcium channel blocker or both at the time of AV block (DU group). No-DU group was significantly younger than DU group. The most common atrial rhythm in both groups was sinus. There was no significant difference in QRS wideness or ventricular rate. AV block regressed in 43% of the DU group after discontinuation of drug for five half-life, but, Mobitz type 2 or complete AV block occurred again during six months in 50% of them without consumption of the culprit drug. Conclusions: More than two third of the patients who developed AV block on beta blocker and/or calcium channel blocker needed permanent pacemaker in six months of follow-up, so we concluded that the development of AV block was not as benign as it seems in these patients.

a b s t r a c tWe report on a 45-year-old female who developed cardiomyopathy due to incessant dual atrioventricular nodal nonreentrant tachycardia. Her condition was completely resolved by performing radiofrequency ablation of the slow pathway.