Life Threatening Right Ventricle and Atrium Perforation and Tricuspid Valve Injury Due to Pacemaker Lead Dislodgment- A Case Report

We report the case of a 63-year-old female patient who was urgently admitted from electrophysiology laboratory (EP Lab) to operating room (OR) with hemodynamic instability and hemothorax. The dual-chamber pacemaker had been implanted 15 years ago. After median sternotomy she was evaluated for perforations and raptures of cardiac chambers and status of right ventricle (RV) lead of permanent pacemaker (PPM) by the surgeon. Evaluations revealed that RV and right atrium (RA) have been ruptured and tricuspid valve has been damaged as a result of dislodgment of RV PPM lead secondary to manipulations in electrophysiology (EP) lab. This lead was withdrawn through SVC and ruptures were repaired and tricuspid valve was replaced. The epicardial pacemaker was placed by the surgeon. After surgery, the patient was transferred to ICU, after three days she was discharged to ward and after 5 days from surgery she was discharged from hospital in good condition.