Interventricular septal perforation as a rare complication of temporary transvenous pacemaker/Gecici transvenoz pacemaker'in nadir bir komplikasyonu: Interventrikuler septal perforasyon.
Interventricular septum perforation is a rare complication of pacemaker implantation, but it may cause death and may be misdiagnosed.
A 70-year-old woman was admitted to the emergency room of another hospital with complete atrioventricular (AV) block with a ventricular rate of 30 beats/min on electrocardiography (ECG). Ventricular tachycardia occurred during temporary pacemaker implantation via right subclavian vein. The patient referred to our hospital after D/C cardioversion. The ECG on admission showed right bundle branch block (RBBB) pacemaker rhythm with a rate of 68 beats/min. The pacemaker lead was not in normal position on chest X-ray.
The RBBB pattern is a useful marker of the left ventricular stimulation. The left ventricular stimulation after temporary or permanent pacemaker implantation is associated with connections formed by the coronary sinus and its branches, intracardiac defects (sinus venosus type defect, patent foramen ovale, atrial septal defect), perforation of interventricular septum and malposition due to inadvertent subclavian artery puncture. The lead position was assessed with transthoracic echocardiography.
The transthoracic echocardiography showed left ventricular hypertrophy (interventricular septum thickness of 16 mm), relaxation disturbance, pacemaker lead passing from the right atrium to the right ventricle and to the left ventricle at the interventricular plane (Fig. 1, 2). The tip of the lead was detected in the left ventricle and this was confirmed with transesophageal echocardiography (Fig. 3).
Echocardiography is very useful in the assessment of the lead location, diagnosis of the pacemaker complications and follow-up. Interventricular septum perforation should be suspected in the presence of RBBB on ECG after implantation of a temporary or permanent pacemaker.
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Tayfun Sahin, Ulas Bildirici, Umut Celikyurt, Aykut Tantan, Teoman Kilic
Department of Cardiology, Medical Faculty of Kocaeli University, Kocaeli, T urkey
Address for Correspondence/Yazisma Adresi: Dr. Umut Celikyurt Department of Cardiology, Medical Faculty of Kocaeli University, Umuttepe Yerleskesi, Eski Istanbul Yolu 10. km, 41380 Kocaeli, Turkey Phone: +90 262 303 86 83 Fax: +90 262 303 80 03 E-mail: email@example.com