Lead related atrial perforation mimicking inferior ST elevation myocardial infarction

Abstract

ST‐elevation myocardial infarction (STEMI) is a life‐threatening clinical condition that requires immediate intervention, mostly caused by complete occlusion of epicardial vessels. Other diseases such as myocarditis, pericarditis, electrolyte disturbance, and early repolarization may mimic. We present a rare case of atrial lead‐related atrial perforation which mimics inferior STEMI.

Delayed perforation of an atrial pacemaker electrode: Lifelong risk for a rare but serious complication

“…Should delayed lead perforation become symptomatic, pleuritic or pericarditis chest pain has been reported in most cases 3 . However, the clinical presentation can be very manifold, ranging from hiccups, diaphragmatic pacing, angina with ST‐segment elevations to hemodynamic instability 9–12 . Regarding the electrical performance of the device, loss of capture or drastic increase in stimulus threshold usually associated with undersensing are the main malfunctions in this context 3,7,13 .…”

“… 3 However, the clinical presentation can be very manifold, ranging from hiccups, diaphragmatic pacing, angina with ST‐segment elevations to hemodynamic instability. 9 , 10 , 11 , 12 Regarding the electrical performance of the device, loss of capture or drastic increase in stimulus threshold usually associated with undersensing are the main malfunctions in this context. 3 , 7 , 13 While risk factors for symptomatic lead perforation such as steroid and anticoagulant use, screw‐in leads, older age, and BMI <20 kg/m 2 have been identified, 14 an understanding of the specific mechanism of perforation remains subject to speculation.…”