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Pneumopericardium and Contralateral Pneumothorax to Venous Access Site after a Biventricular Permanent Pacemaker Implantation

Ramon Martos, Sulaiman Khadadah, Husaiman Alsaleh, Brendan Foley and Jhonny Dodd

A 79-year-old female underwent implantation of a left sided biventricular permanent pacemaker for symptomatic severe heart failure with active fixation leads. Twelve hours after the procedure, the patient complained of pleuretic chest pain and was found to have a 10-15% right pneumothorax on a thorax CT scan. Patient was managed conservatively, successfully relieving the symptoms. The CT scan of the chest also revealed extrusion of the helix of the screw-in atrial lead, through the wall of the right atrial appendage. The helix was adjacent to a bulla in the right lung, the likely cause for pneumothorax and pneumopericardium. The atrial lead was repositioned the following day without complications.