부산대학교 도서관

Complications of pacemaker implantation such as pneumothorax during venipuncture and cardiovascular injury during lead insertion, have been reported. With an incidence of about 1％, cardiac perforation is considered rare. However, it is a serious complication that may lead to cardiac tamponade and death. We report a case of a 70-year-old woman with a pneumothorax identified during post-operative follow-up. Eleven days after pacemaker implantation using an active fixation lead, a chest CT scan revealed a right pulmonary bulla and right pneumothorax. In addition, an elevated atrial pacing threshold and pericardial effusion were observed, and a pneumothorax due to lead perforation was suspected. In the surgical management of the right pneumothorax, thoracoscopy revealed that the tip of the active fixation lead had penetrated the right atrial wall and perforated the pericardium and pleura at a diameter of about 3mm on the ipsilateral side. The adjacent middle lobe of the right lung had been injured. Therefore, the pulmonary bulla was resected, the injured lung was repaired, and the lead was removed. When changes in threshold for endocardial wave height and abnormalities in the adjacent organs of the lead implantation site are observed, lead perforation should be suspected. If there is a perforation, removal should be actively considered.