Treatment of permanent pacemaker electrode-induced cardiac perforation

Abstract

A case of permanent pacemaker electrode-induced perforation in the Third Affiliated Hospital of Inner Mongolia Medical University was collected and analyzed on the basis of diagnosis, physical examination and treatment. Cardiac perforation is one of the most serious complications of pacemaker implantation. As this disease is rare, it is easy to be misdiagnosed or missed diagnosis. We hope to improve the clinician's awareness and vigilance of permanent pacemaker electrode perforation by analyzing the data of this case.Key Words: Pacemaker, Electrode perforation 1 Medical record General informationA 79-year-old male was admitted to our department on May 20, 2010 due to repeated dizziness, fatigue for five years' duration, aggravating with syncope 4 times in one year. The patient presented with dizziness, fatigue five years ago, without chest tightness, chest pain, or paroxysmal nocturnal dyspnea. The symptoms have not been taken seriously and the patient was not given any treatment. In the past year, the symptoms increased and syncope occurred 4 times. There were no obvious causes, and each attack lasted 1-2 min, the patient turned to be conscious of himself afterwards. Since the onset, the spirit and diet are normal with no change in weight. History of hypertension or diabetes was denied. Physical examinationT 36.5°C, P 48 beats/min, R 16/min, blood pressure 110/80 mmHg. The patient was conscious with an active position. The breathing was smooth and the chest was symmetric. Double lung breath sounded resonance, and no dry or wet rales were heard. The heart rate was 48 beats/min, showing regularity in the force and rhythm of the heartbeat. No noises were heard in each valve during auscultation. Abdomen soft, mild epigastric tenderness, without rebound tenderness and muscle tension. No enlargement of liver, spleen and kidneys beneath the rib was found, nor edema of lower limbs. 2015, Vol. 2, No. 3 in cranial CT. Auxiliary examination Primary DiagnosisSick sinus syndrome (slow-fast type). Diagnosis and treatmentThe patient had a permanent pacemaker implanted in class I indications. For economic reasons, the patient was given implantation of ventricular single chamber pacemakers (VVI). Permanent pacemaker implantation was performed on the third day after admission. The operation was successful. The pacing threshold was 0.3 V, the impedance was 536 Ω, the R wave height was 9.8 mv, and the pacing was normal. The pacing ECG was shown in Figure 1, and the intraoperative image was shown in Figure 2. The patient took out-of-bed activity at 24 h after operation, and the ECG monitoring showed that the pacing perception function was normal. On the third day of operation, the pacemaker performed pacing disturbance. The pacing signal showed no QRS wave group and was normal (see Figure 3). The patient had no chest pain, abdominal pain, palpitation nor shortness of breath. X-ray examination showed that the electrode was located at the apex of the right ventricle (see Figure 4). No pericardial effusion was found over ...