Cardiac Perforation after Pacemaker Implantation;Report of a Case

A 71-year-old woman was diagnosed with sick sinus syndrome (SSS) upon her cardiogenic cerebral embolism and underwent pacemaker implantation. Active fixation leads were positioned at the right atrial appendage and ventricular septum. Twenty-one days later at her routine checkup, she was asymptomatic and there were no signs of cardiac tamponade or pacing failure. But echocardiography and computed tomography revealed a large amount of pericardial effusion due to the lead perforation. We performed open drainage because her anticoagulant could not be stopped for her history of cerebral infarction. Upon surgery, 400 ml of hemorrhagic pericardial effusion was drained and we found a lead tip penetrating through the right atrial appendage. We should carefully observe for lead perforation after pacemaker implantation, especially when using the active fixation lead.