Case presentation
An 80-year-old female patient was admitted to our hospital due to
dyspnea lasting 3 days. This patient had a dual-chamber pacemaker
implantation one month earlier due to sick sinus syndrome with an active
fixation lead (Medtronic 5076) in the right atrial appendage and another
(Medtronic 5076) in the right ventricular apex. Her vital signs were
stable after admission. Echocardiography revealed massive pericardial
effusion. Pacemaker programming showed pacing parameters of two leads
were both good. Chest X-ray showed that both leads were within cardiac
silhouette (Figure 1A). Computed tomographic angiography (CTA)
with sagittal multiplanar reconstruction showed the tip of the atrial
lead protruded slightly beyond the epicardial fat pad (Figure1B), suggesting a potential atrial lead perforation. Then
pericardiocentesis was performed to guard against cardiac tamponade, and
hemorrhagic fluid was drained without blood clot, which deepened the
suspicion of perforation. Therefore, a small incision operation was
performed. During the operation, it was found that the position of the
atrial lead was unfixed, and the penetrated part was so short that it
appeared as a dot when penetrated, and then disappeared in the surgical
field, repeatedly (Figure 1C, D). Afterwards, cardiac was
repaired and the criminal lead was embedded. After several days of
observation, pericardial effusion disappeared.