Images in Cardiovascular Medicine
David Hennessy, MB BCh Nicholas McKeag, MB BCh, PhD Michael Roberts, MD Daniel Flannery, MD Richard McConville, MB BCh
Pneumopericardium after Permanent Pacemaker Implantation
A
n 87-year-old man presented at the hospital with shortness of breath and syncope. His medical history included ischemic heart disease, emphysema, and hypertension. An electrocardiogram showed complete heart block and nonsustained polymorphic ventricular tachycardia. A temporary ventricular pacing wire was inserted. In the coronary care unit, the patient was treated for a communityacquired chest infection. A dual-chamber permanent pacemaker (PPM) was inserted by means of left cephalic vein cutdown. Active-fixation leads were used. After implantation, a device check, lead check, and chest radiograph revealed nothing abnormal. Eight days later, the patient had dyspnea and hemoptysis. A chest radiograph showed patchy consolidation in the lower zone of both lung fields, the right atrial pacing lead’s tip situated outside the cardiac silhouette, and evidence of pneumopericardium (Fig. 1). At the regional cardiology center, the right atrial pacing lead was uneventfully removed and replaced with a passive-fixation lead. The patient was discharged from the center 3 days later.
Comment
Section Editor: Raymond F. Stainback, MD, Department of Adult Cardiology, Texas Heart Institute, 6624 Fannin St., Suite 2480, Houston, TX 77030 From: Cardiology Department (Dr. Roberts), Royal Victoria Hospital, Belfast BT12 6BA; and Cardiology Department (Drs. Flannery, Hennessy, McConville, and McKeag), Craigavon Area Hospital, Portadown BT6 3QQ; Northern Ireland, United Kingdom
Permanent pacemaker implantation is associated with a complication rate of approximately 7%.1 Typical sequelae are pocket hematoma, pneumothorax, lead displacement, tamponade, and infection.2 Pneumopericardium is a very rare sequela that can progress to tension pneumopericardium and cardiac tamponade.3 Cardiac perforation after PPM implantation is also infrequent (incidence,
David Hennessy, MB BCh Nicholas McKeag, MB BCh, PhD Michael Roberts, MD Daniel Flannery, MD Richard McConville, MB BCh
Pneumopericardium after Permanent Pacemaker Implantation
A
n 87-year-old man presented at the hospital with shortness of breath and syncope. His medical history included ischemic heart disease, emphysema, and hypertension. An electrocardiogram showed complete heart block and nonsustained polymorphic ventricular tachycardia. A temporary ventricular pacing wire was inserted. In the coronary care unit, the patient was treated for a communityacquired chest infection. A dual-chamber permanent pacemaker (PPM) was inserted by means of left cephalic vein cutdown. Active-fixation leads were used. After implantation, a device check, lead check, and chest radiograph revealed nothing abnormal. Eight days later, the patient had dyspnea and hemoptysis. A chest radiograph showed patchy consolidation in the lower zone of both lung fields, the right atrial pacing lead’s tip situated outside the cardiac silhouette, and evidence of pneumopericardium (Fig. 1). At the regional cardiology center, the right atrial pacing lead was uneventfully removed and replaced with a passive-fixation lead. The patient was discharged from the center 3 days later.
Comment
Section Editor: Raymond F. Stainback, MD, Department of Adult Cardiology, Texas Heart Institute, 6624 Fannin St., Suite 2480, Houston, TX 77030 From: Cardiology Department (Dr. Roberts), Royal Victoria Hospital, Belfast BT12 6BA; and Cardiology Department (Drs. Flannery, Hennessy, McConville, and McKeag), Craigavon Area Hospital, Portadown BT6 3QQ; Northern Ireland, United Kingdom
Permanent pacemaker implantation is associated with a complication rate of approximately 7%.1 Typical sequelae are pocket hematoma, pneumothorax, lead displacement, tamponade, and infection.2 Pneumopericardium is a very rare sequela that can progress to tension pneumopericardium and cardiac tamponade.3 Cardiac perforation after PPM implantation is also infrequent (incidence,
