PERFORATION OF THE RIGHT ATRIUM WITH THE DEVELOPMENT OF RIGHT-SIDED PNEUMOTHORAX AND PNEUMOPERICARDIUM IN A PATIENT WITH AN IMPLANTED DUAL-CHAMBER PACEMAKER

Abstract

Development of pneumothorax after pacemaker implantation is an uncommon complication. Pneu-mothorax, contralateral to venous access site, due to atrial lead perforation is a more rare complication. The most frequently reported predictors of lead perforation are active fixation leads, low body mass index, older age, female gender and concomitant anticoagulation therapy. We described a clinical case of a 69-year-old patient who had undergone radiofrequency abla-tion of atrial fibrillation several years earlier. Several years later, the patient developed sick sinus syndrome (chronotropic incompetence) and bifascicular block, as a result of which he was implant-ed with a dual-chamber pacemaker, which was subsequently complicated by perforation of the right atrial appendage with damage to the middle lobe of the right lung with the development of pneu-mothorax and pneumopericardium. Described cases illustrates that if right pneumothorax symptoms occur in a patient where the device was placed from a left subclavian approach, perforation of the atrial appendage should be excluded. By far the preferred method of diagnosing this complication today is chest CT scan.

Keywords

• perforation of the appendage of the right atrium
• pneumopericardium
• right-sided pneu-mothorax.