Cardiac perforation of the right ventricle: A rare complication of pacemaker implantation. The importance of a collaborative vision of a multi-disciplinary treatment team

The use of implantable cardiac devices has increased in the last 30 years. The evolution of devices in serious cardiac rhythm pathology management has led progressively to the development of devices for the treatment of bradycardia, ventricular arrhythmia, and heart failure and for the prevention of sudden cardiac arrest leading to delivery of pacemakers, implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) plus ICD (CRT-D) [ 1 Calvagna G.M. Patanè S. Severe Staphylococcal sepsis in patient with permanent pacemaker. Int J Cardiol. Apr 1 2014; 172 ([Epub 2014 Jan 23]): e498-e501 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 2 Ward C. Henderson S. Metcalfe N.H. A short history on pacemakers. Int J Cardiol. Nov 15 2013; 169: 244-248 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar , 3 Schulman P.M. Rozner M.A. Sera V. Stecker E.C. Patients with pacemaker or implantable cardioverter–defibrillator. 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Magalhaes M.A. Lipinski M.J. Baker N.C. Minha S. Torguson R. et al. Mortality in patients requiring pacemaker implantation following transcatheter aortic valve replacement: Insights from a systematic review and meta-analysis. Int J Cardiol. Jun 1 2014; 174: 207-208 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ], the progressively younger implanted population and the increase in device and procedure complexity have raised the risk of system component structural failures [ 51 Pugliatti P. Donato R. Di Bella G. Carerj S. Patanè S. Contrast-enhancing right atrial thrombus in cancer patient. Int J Cardiol. May 15 2014; 173: e35-e37 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar , 52 Pugliatti P. Donato R. Zito C. Carerj S. Patanè S. Cardio inhibitory vasovagal syncope in a cancer patient. Int J Cardiol. Jun 15 2014; 174: e64-e65 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar , 53 Patanè S. Cardiotoxicity: cisplatin and long term cancer survivors. Int J Cardiol. Jul 15 2014; 175: 201-202 Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar , 54 Patanè S. A challenge in cardiology: the oncosurgery. Int J Cardiol. Jun 15 2014; 174: 411-412 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar , 55 Patanè S. Heart failure and breast cancer: emerging controversies regarding some cardioprotective strategies. J Card Fail. Jun 2014; 20: 456-457 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar , 56 Patanè S. Insights into cardio-oncology: adrenergic receptor signaling and pathways in breast cancer. Curr Med Res Opin. Jun 26 2014; ([http://informahealthcare. com/doi/full/10.1185/03007995.2014.932636]): 1-2 Crossref PubMed Scopus (1) Google Scholar , 57 Patanè S. Breast cancer treatment cardioprotective strategies: the King is naked. J Am Heart Assoc. 2014; ([Published July 22,2014 http://www.jaha.ahajournals.org/content/3/2/e000665/reply]) Google Scholar , 58 Patanè S. ERBB1/EGFR and ERBB2 (HER2/neu) — targeted therapies in cancer and cardiovascular system with cardiovascular drugs. Int J Cardiol. Oct 20 2014; 176: 1301-1303 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar , 59 Patanè S. Cancer multidrug resistance — targeted therapy in both cancer and cardiovascular system with cardiovascular drugs. Int J Cardiol. Oct 20 2014; 176: 1306-1308 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar , 60 Patanè S. HERG — targeted therapy in both cancer and cardiovascular system with cardiovascular drugs. Int J Cardiol. Oct 20 2014; 176: 1082-1085 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar , 61 Patanè S. Ebola: is there a hope from treatment with cardiovascular drugs?. Int J Cardiol. 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Leads extraction in a young girl with dehiscence of a pacemaker implanted in the subpectoral region. Int J Cardiol. Aug 5 2014; 176: e135-e136 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar , 67 Romeo P. Calvagna G.M. Giunta M. Vitale F.V. Patanè S. Removal of an intracardiac lost port — a catheter utilizing a simple low-cost method. Int J Cardiol. Aug 2 2014; 176: 1309-1311 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar , 68 Viswanathan K. Lewis N. Pepper C. An unusual defibrillator lead complication identified at explant. Int J Cardiol. Jun 15 2014; 174: e66-e67 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 69 Inciardi R.M. Rotolo A. Coppola G. Clemenza F. Giordano U. Lombardo E. et al. Treatment decision making in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy: state of the art. Int J Cardiol. Jun 1 2014; 174: 191-192 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 70 Rodriguez Y. Garisto J. Carrillo R.G. Management of cardiac device-related infections: a review of protocol-driven care. Int J Cardiol. Jun 5 2013; 166: 55-60 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar , 71 Escárcega R.O. Magalhaes M.A. Lipinski M.J. Baker N.C. Minha S. Torguson R. et al. Mortality in patients requiring pacemaker implantation following transcatheter aortic valve replacement: Insights from a systematic review and meta-analysis. Int J Cardiol. Jun 1 2014; 174: 207-208 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 72 Kusumoto S. Kawano H. Makita N. Ichimaru S. Kaku T. Haruta D. et al. Right bundle branch block without overt heart disease predicts higher risk of pacemaker implantation: the study of atomic-bomb survivors. Int J Cardiol. Jun 1 2014; 174: 77-82 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar ]. Cardiac perforation of the right ventricle (RV) is a rare but potentially life-threatening complication [ 73 Migliore F. Zorzi A. Bertaglia E. Leoni L. Siciliano M. De Lazzari M. et al. Incidence, management, and prevention of right ventricular perforation by pacemaker and implantable cardioverter defibrillator leads. Pacing Clin Electrophysiol. Jul 29 2014; https://doi.org/10.1111/pace.12472 Crossref PubMed Scopus (55) Google Scholar , 74 Pojar M. Vobornik M. Novy J. Left hemothorax: an unusual complication of delayed right ventricular perforation by a permanent pacemaker lead. J Card Surg. May 2013; 28: 325-327 Crossref PubMed Scopus (5) Google Scholar ] in a young woman undergoing pacemaker implantation. Closer link between all health care system operators should be seen as an achievable goal for patient's safety and encouragement. We describe the case of a cardiac perforation of the right ventricle (RV) in a young woman undergoing single-chamber VVI pacemaker implantation with active fixation in the right ventricle apex. After pacemaker implantation the patient complained of chest pain. A chest X-ray (Fig. 1 Panel A) and a computed tomography (Fig. 1 Panels B, C, D and E) revealed a cardiac perforation of the right ventricle (RV) and a heart surgery intervention was performed successfully through a full sternotomy (See Fig. 2). This case focuses on the cardiac perforation of the right ventricle (RV) as a rare but potentially life-threatening complication of pacemaker implantation and on the importance of a collaborative vision of a multi-disciplinary treatment team. Fig. 2A heart surgery intervention was performed successfully. View Large Image Figure Viewer Download Hi-res image