Case presentation:
A 83-year-old female (height, 148cm; weight, 41.5kg; body mass
index,18.9 kg∙m−2) suffered from sinus arrest of 5
seconds with paroxysmal atrial flutter and was admitted to our hospital
for leadless pacemaker implantation. The patient had percutaneous
coronary intervention with 2 stents implantation 1 month before
admission and dual anti-platelet therapy of aspirin (100mg/day) and
clopidogrel (75mg/day) continued to the procedure day. During the
procedure, the patient was received intravenous heparin 50u/kg before
Micra TPS was introduced into the right femoral vein. Then the delivery
catheter was directed across the tricuspid valve but was accidently
performed into the coronary sinus for several times. The device cup was
placed at the beginning of the posterior branch of coronary sinus as
confirmed by angiography (Figure 1 ). Simultaneously,
pericardial effusion was detected at the left anterior oblique view
(Figure 1B, 1C ). But the patient was asymptomatic and remained
hemodynamically stable (blood pressure 134/76mmHg). After adjusting the
direction of the catheter, it was finally successfully performed into
the right ventricle and Micra leadless pacemaker was deployed at the
apex of right ventricle (Figure 2 ) with good pacing parameters
(R wave amplitude, 9mV; threshold, 0.38V/0.24ms; impedance, 1000Ω). At 2
hours post-procedure, the patient was found pericardial tamponade with
blood pressure dropped to 75/58 mmHg. Medium amount of pericardial
effusion mainly distribution around the posterior wall of left ventricle
was confirmed by echocardiogram (Figure 3 ). The patient was
emergently received pericardiocentesis and drainage of 270 ml bloody
fluid. The symptoms were immediately relieved with blood pressure rise
to 130/80 mmHg. The pacing parameters remained stable. Dual
anti-platelet therapy was stopped for 5 days. No evidence of distinct
pericardial effusion was detected after the drainage tube removal.
Aspirin (100mg/day) and rivaroxaban (5mg/day) were prescribed
afterwards. The patient was discharged without pericardial effusion
reconfirmed by echocardiogram.