Lead Perforation Into the Left Internal Mammary Artery Causing Circulatory Collapse After Pacemaker Insertion

Rajesh Kumar; Jathinder Kumar; Ihsan Ullah; Sadat Ali Edroos; Sajjad Matiullah

doi:10.1016/j.jaccas.2022.01.012

Lead Perforation Into the Left Internal Mammary Artery Causing Circulatory Collapse After Pacemaker Insertion

JACC Case Rep. 2022 Mar 2;4(5):315-317. doi: 10.1016/j.jaccas.2022.01.012.

Authors

Rajesh Kumar¹, Jathinder Kumar¹, Ihsan Ullah¹, Sadat Ali Edroos², Sajjad Matiullah¹

Affiliations

¹ Department of Cardiology, St James's Hospital, Dublin, Ireland.
² Department of Cardiology, Luton and Dunstable University Hospital, Bedfordshire, United Kingdom.

Abstract

A 66-year-old woman underwent a pacemaker implantation following a symptomatic pause. The pacemaker lead inadvertently punctured the ventricle during implantation, penetrating through to the left internal mammary artery, causing slow hemorrhage. There was subsequent circulatory collapse with shock. We describe this rare yet life-threatening condition. (Level of Difficulty: Intermediate.).

Keywords: CT, computed tomography; CXR, chest x-ray; LIMA, left internal mammary artery; RV, right ventricle; actively fixated pacemaker lead; bradycardia; cardiac CT; cardiac pacemaker; complications.