Abstract
BACKGROUND: Various complications of permanent pacemaker implantation have been reported. However, late pacemaker lead-related myocardial perforation rarely occurs. Conservative treatment is generally selected, if possible, but open heart surgery or catheter lead removal should be considered in symptomatic patients. We herein describe a patient who was successfully treated by pericardial repair and coverage for late pacemaker lead-related atrial perforation and pneumothorax. CASE PRESENTATION: A woman in her 80s who had undergone permanent pacemaker implantation 2 years previously visited our hospital because of dyspnea. She had also been treated for right pneumothorax 1 year previously. A chest radiograph and computed tomography scan showed right pneumothorax and pericardial emphysema with no effusion. Because similar findings had been obtained at the previous onset of pneumothorax, we suspected delayed myocardial perforation and lung injury due to the screw-in lead in the right atrium. No myocardial bleeding, cardiac tamponade, or pacing failure was present. The cardiovascular surgeon judged that open-heart lead extraction would be difficult because of the patient's poor performance status; therefore, thoracoscopic pericardial repair with an expanded polytetrafluoroethylene sheet and coverage with anterior mediastinal adipose tissue was attempted to prevent recurrent pneumothorax. The patient was successfully treated without lead extraction or open heart surgery. At 1.5 years postoperatively, she had developed no recurrence of pneumothorax or pacing failure. CONCLUSIONS: Pericardial repair and coverage can be an effective strategy for pacemaker lead-related pneumothorax without pacing failure or bleeding.