A case of cardiac tamponade due to coronary artery injury caused by atrial screw-in lead

Abstract

Pacemaker implantation (PMI) is a standard treatment for symptomatic bradyarrhythmia. Pneumothorax, aortic perforation, and pericardial effusion were reported as major complications of this procedure [1,2]. A cohort study in Denmark found that the incidence was 9.5% of 5918 patients who were implanted with a cardiac implantable electronic device (CIED), among which cardiac perforation was 0.6%, the male to female ratio was 1.1% vs 0.4% [2]. In the study of the recipients of permanent pacemakers from 2008 to 2012 in the USA, cardiac tamponade occurred in 2595 cases, which was 0.28% for the implantation of 922,549 patients [3]. Many cases can be managed conservatively with drainage or lead revision, but sometimes surgical intervention is required. We report a rare case of cardiac tamponade due to injury of the coronary artery by an atrial screw-in lead. Case reportA 74-year-old man visited the emergency room because of syncope. He was diagnosed with bradycardia tachycardia syndrome two years previously with presyncope. At that time, he took no drug that could cause bradycardia. Ambulatory electrocardiographic monitoring revealed maximum of 5 sec sinus arrest after the termination of atrial fibrillation, but he refused PMI. At

Coronary artery complications with left bundle branch area pacing: A review of literature

“…During LBBAP implantation, the positioning of the pacing lead in the left bundle branch area can potentially cause mechanical trauma to the surrounding coronary arteries 9 . The manipulation of the lead and its placement in proximity to the coronary arteries may result in direct injury, including endothelial damage, intimal disruption, or dissection 10 . Mechanical trauma can trigger a cascade of events leading to complications such as stenosis or thrombosis 11 …”

“…9 The manipulation of the lead and its placement in proximity to the coronary arteries may result in direct injury, including endothelial damage, intimal disruption, or dissection. 10 Mechanical trauma can trigger a cascade of events leading to complications such as stenosis or thrombosis. 11…”