Perforation of the Right Ventricular Wall by Temporary Pacemaker Wire

An 82-year-old woman was admitted to the hospital with an inferior acute myocardial infarction and developed 3rd-degree atrioventricular block. A temporary pacemaker wire was inserted, and the next day she returned to sinus rhythm; however, the wire was left in place. Coronary angiography revealed triple-vessel disease, and a decision was made to perform surgery rather than percutaneous intervention. A hemopericardium was seen upon opening the pericardium, and the pacemaker wire was found to be perforating the right ventricular wall (Fig. 1A). The wire was removed and the wound sutured, which stopped the profuse bleeding (Fig. 1B). The patient underwent off-pump triple-vessel coronary artery bypass grafting and had an uneventful recovery. Surgery proved to be the right choice for this patient; with another procedure, pacemaker wire withdrawal might have been followed by cardiac tamponade, which would have compromised the outcome.

Fig. 1 A) Pacemaker wire is protruding from the right ventricle. B) The wound is repaired and the bleeding stopped.