Fluoroscopy to assess late heart and lung perforation by a permanent ventricular pacemaker lead. A case complicated by isolated hemothorax

We report a female patient with a ventricular lead perforation late after implantation. The lead perforated heart and lung parenchyma and caused hemothorax but no cardiac effusion or tamponade. No definitive evidence for lead perforation was found by standard diagnostic assessment. Definitive diagnosis was established by cath-lab fluoroscopy. The surgical treatment including thoracotomy, lead removal, repair suture of the right ventricle and finally placement of an epicardial electrode was successful.