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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 90-year-old male patient transferred from another hospital with a diagnosis of pacemaker dysfunction&#46; A permanent pacemaker had been placed one month previously for complete atrioventricular block&#46; At a scheduled checkup with his cardiologist&#44; he reported that he had started experiencing exertional dyspnea and pleuritic pain a few days after discharge&#46; The electrocardiogram showed atrioventricular block with failure of pacemaker capture&#46; The physical exam was unremarkable and he was hemodynamically stable&#46; Suspecting lead malposition or fracture&#44; a chest X-ray and transthoracic echocardiography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41; were performed which showed the lead perforating the right ventricle &#40;arrow&#41; and mild cardiac effusion&#46; Computed tomography &#40;CT&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B and C&#41; was then performed in order to identify the entire course of the lead&#46; After multidisciplinary discussion involving our surgical and electrophysiological team&#44; it was decided to disconnect the old lead and leave it in place&#44; as the wound was sealed&#44; and to place a new passive fixation electrode &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41;&#46; The patient has been asymptomatic with a good clinical course since the procedure&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Lead perforation is a relatively rare complication after pacemaker implantation&#46; Its presentation varies from life-threatening situations such as cardiac tamponade to mild and nonspecific symptoms&#46; It should be suspected if the patient presents days after implantation with pleuritic pain&#44; dyspnea&#44; hiccup or device malfunction&#46; The gold standard for the diagnosis is CT&#44; and treatment consists of device extraction&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In our case&#44; given the patient&#39;s stability and characteristics&#44; an unconventional approach was adopted&#44; with a good outcome as far as we know&#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="par0020" 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="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Image in Cardiology
Active fixation pacemaker lead perforating cardiac wall
Elétrodo de fixação ativa do pacemaker perfurando parede cardíaca
Elena Velasco
Autor para correspondência
elenavelal@gmail.com

Corresponding author.
, María Martín, Vicente Barriales, Elena Díaz, Federico Pun, María Isabel Soto
Division of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 90-year-old male patient transferred from another hospital with a diagnosis of pacemaker dysfunction&#46; A permanent pacemaker had been placed one month previously for complete atrioventricular block&#46; At a scheduled checkup with his cardiologist&#44; he reported that he had started experiencing exertional dyspnea and pleuritic pain a few days after discharge&#46; The electrocardiogram showed atrioventricular block with failure of pacemaker capture&#46; The physical exam was unremarkable and he was hemodynamically stable&#46; Suspecting lead malposition or fracture&#44; a chest X-ray and transthoracic echocardiography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41; were performed which showed the lead perforating the right ventricle &#40;arrow&#41; and mild cardiac effusion&#46; Computed tomography &#40;CT&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B and C&#41; was then performed in order to identify the entire course of the lead&#46; After multidisciplinary discussion involving our surgical and electrophysiological team&#44; it was decided to disconnect the old lead and leave it in place&#44; as the wound was sealed&#44; and to place a new passive fixation electrode &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41;&#46; The patient has been asymptomatic with a good clinical course since the procedure&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Lead perforation is a relatively rare complication after pacemaker implantation&#46; Its presentation varies from life-threatening situations such as cardiac tamponade to mild and nonspecific symptoms&#46; It should be suspected if the patient presents days after implantation with pleuritic pain&#44; dyspnea&#44; hiccup or device malfunction&#46; The gold standard for the diagnosis is CT&#44; and treatment consists of device extraction&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In our case&#44; given the patient&#39;s stability and characteristics&#44; an unconventional approach was adopted&#44; with a good outcome as far as we know&#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="par0020" 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="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Transthoracic echocardiography&#44; subcostal view&#44; showing the pacemaker lead perforating the right ventricle &#40;arrow&#41;&#59; &#40;B&#41; and &#40;C&#41; cardiac computed tomography showing the entire pacemaker lead and the perforation through the right ventricle&#59; &#40;D&#41; chest X-ray at discharge showing the two leads &#40;arrows&#41;&#46; Black arrow&#58; new lead&#44; yellow arrow&#58; old lead perforating the cardiac wall&#46;</p>"
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