Læknablaðið - 15.04.2013, Blaðsíða 14

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ENGLISH SUMMARY
Cardiac perforation following pacemaker implantation - a case series from lceland
Sverrisson ITh’, Hognason J2, Vidarsdottir H', Gottskalksson G2, Gunnarsson GTh3, Sverrisson JTh3, Gudbjartsson T'-4
Introduction: Perforation of the heart is a serious complication follow-
ing pacemaker implantation that can cause life threatening bleeding and
cardiac tamponade. Here we describe five cases that were diagnosed in
lceland during a four year period.
Materials and methods: This population-based case series includes
five patients diagnosed with cardiac perforation following pacemaker
insertion at Landspítali and Akureyri Hospital from January 1, 2007
to December 31, 2010. The mode of detection, treatment given and
outcome were studied.
Results: Altogether five patients (mean age 71 years, three females)
were diagnosed with cardiac perforation in lceland during the study
period, one in 2008 and four in 2009. Chest pain was the most
common presenting symptom (n=4) and no patient had acute cardiac
tamponade. In all five cases the diagnosis was obtained with computed
tomography scan or echocardiography. No perforation was detected
intraoperatively but four of the cases were diagnosed within three weeks
of the operation. Three patients were treated with surgical evacuation
of blood via sternotomy and suture of the perforation. In the other two
cases the pacemaker leads were removed in the operating room with
trans-oesophageal echocardiographic guidance. Four patients survived
the treatment and were discharged but one died of pneumonia in the
intensive care unit.
Conclusion: Cardiac perforation is a serious complication and should
be kept in mind in patients with chest pain following pacemaker inser-
tion.
Key words: Pacemaker implantation, cardiac perforation, complications, treatment, mortality.
Correspondence: Tómas Guðbjartsson, tomasgud@iandspitaii.is
'Departments of Cardiothoracic Surgery and !Cardiology National University Hospitai of lceland, Reykjavík. 3Department of internai Medicine, Akureyri Hospital, *Facuity of Medicine,
University of lceland.
186 LÆKNAblaðið 2013/99