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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multidetector computed tomography with multiplanar reconstruction in sagittal oblique view&#44; showing the position of the lead tip outside the heart in the anterior mediastinum&#44; above the diaphragm&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 74-year-old woman had undergone implantation of a permanent pacemaker &#40;VDD&#41; for grade 3 atrioventricular block two years previously&#44; with no intervening complications&#46; At a routine follow-up consultation&#44; although she presented no symptoms&#44; pacemaker dysfunction was detected &#40;undersensing and failure to capture&#41;&#46; A posteroanterior chest X-ray showed the pacemaker lead tip protruding outside the heart &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; Thoracic 16-slice multidetector computed tomography&#44; with multiplanar and three-dimensional reconstructions&#44; confirmed the position of the lead tip outside the heart&#44; with an intrathoracic course towards the diaphragm &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figures 2&#8211;4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Perforation of the myocardium by a pacemaker lead is a major&#44; albeit uncommon&#44; complication of such devices&#44; with an incidence of 0&#46;3&#8211;1&#46;2&#37;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Perforations are classified as acute &#40;5&#8211;7 days after device implantation&#41;&#44; subacute &#40;7&#8211;30 days&#41; or late &#40;more than 30 days&#41;&#46; Most cases reported in the literature occurred in the first year&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Most patients with myocardial perforation are symptomatic&#44; with chest pain&#44; dyspnea&#44; hypotension or pacemaker dysfunction&#46; Occasionally there may be symptoms triggered by stimulation of the chest wall muscles or hiccups through stimulation of the diaphragm&#46; More rarely&#44; as in the present case&#44; the patient can be completely asymptomatic&#44; and a high level of suspicion is required&#46; Conventional X-ray and computed tomography can confirm the diagnosis and determine the lead course&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Valentim MH&#44; et al&#46; Perfura&#231;&#227;o tardia do mioc&#225;rdio por cateter de pacemaker em doente assintom&#225;tica&#46; Rev Port Cardiol&#46; 2013&#46; <span class="elsevierStyleInterRef" id="intr0005" href="doi:10.1016/j.repc.2012.10.009">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;repc&#46;2012&#46;10&#46;009</span></p>"
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Image in cardiology
Late myocardial perforation by pacemaker lead in an asymptomatic patient
Perfuração tardia do miocárdio por cateter de pacemaker em doente assintomática
Maria Helena Valentima,
Corresponding author
mariahelenavalentim@gmail.com

Corresponding author.
, Ana Cristina Ferreirab, Carla Saraivaa
a Serviço de Radiologia, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
b Serviço de Cardiologia, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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    "fechaAceptado" => "2012-10-22"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Valentim MH&#44; et al&#46; Perfura&#231;&#227;o tardia do mioc&#225;rdio por cateter de pacemaker em doente assintom&#225;tica&#46; Rev Port Cardiol&#46; 2013&#46; <span class="elsevierStyleInterRef" id="intr0005" href="doi:10.1016/j.repc.2012.10.009">http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;j&#46;repc&#46;2012&#46;10&#46;009</span></p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior chest X-ray&#44; showing the pacemaker lead tip outside the heart&#44; below the contour of the left hemidiaphragm&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multidetector computed tomography&#44; with multiplanar reconstruction in oblique axial view&#44; showing the lead course&#44; initially intraventricular and then passing through the right ventricular free wall&#44; with its tip in the paracardiac fat on the left side&#44; close to the chest wall&#46; No pericardial effusion or significant changes in mediastinal fat were observed&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multidetector computed tomography with multiplanar reconstruction in sagittal oblique view&#44; showing the position of the lead tip outside the heart in the anterior mediastinum&#44; above the diaphragm&#46;</p>"
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Article information
ISSN: 21742049
Original language: English
DOI:10.1016/j.repce.2013.06.009
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