Perforation of the Heart by a Permanent Transvenous Pacemaker

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Abstract
Perforation of the right ventricle by an electrode catheter designed for long-term cardiac pacing is reported. Erratic pacing was noted on the 5th day after placement of the catheter tip in the apex of the right ventricle. Two days later consistent pacing suddenly resumed, associated with simultaneous contractions of the left hemidiaphragm. Tamponade did not develop. Thoracotomy revealed the tip of the catheter emerging from the apex of the right ventricle and lying in the pericardial sac adjacent to the left phrenic nerve. The catheter was removed uneventfully. The small size of the right ventricular cavity in this case may have contributed to this complication by tethering the catheter relatively near its tip, thus allowing excessive force to be developed by the tip against the myocardium.

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