Extract

A 45-year-old male experienced cardiopulmonary arrest while being transported to the hospital for loss of consciousness, with spontaneous circulation restored following cardiopulmonary resuscitation (CPR). Upon hospitalization, the patient presented with prolonged sinus arrest and hypotension, necessitating the implantation of a temporary pacemaker positioned towards the ventricular septum via the right jugular vein. Coronary angiography revealed no significant stenoses. The pacing threshold remained stable; however, on the sixth day post-implantation, the patient developed pulseless electrical activity associated with hypoxia, which required additional CPR. Pre- and post-resuscitation chest radiographs indicated a change in lead position, and chest computed tomography suggested perforation of the lead through the right ventricular free wall (Panel A, yellow arrow). Right ventricular angiography (RVG), performed with right anterior oblique 33 caudal 13 view (Panels B and D; Supplementary data online, Video S1) and left anterior oblique 90 view (Panels C and E; Supplementary data online, Video S2), confirmed that the lead had perforated the endocardium (yellow arrows). In preparation for emergency open chest surgery, the lead was removed using simple traction under fluoroscopic guidance. Subsequent RVG demonstrated no leakage of contrast medium into the pericardial cavity. After lead removal, a transthoracic echocardiogram revealed only trivial pericardial effusion, and sinus arrest did not recur during hospitalization, with adequate oxygenation.

You do not currently have access to this article.