Case report：Treatment of subacute right ventricular apical perforation caused by ventricular electrode with intermittent slow and gradual traction

Objective: We report a rare and severe case of subacute right ventricular apical myocardial perforation caused by ventricular electrode. Due to the lack of clear guidance, it is a great challenge for clinical diagnosis and treatment. Case introduction: A 78-year-old slim and weak woman underwent implantation of dual chamber permanent pacemaker to treat sick sinus syndrome 2 weeks ago. The atrial electrode was located in the right atrial appendage, and the ventricular electrode was located in the right ventricular apex of the lower septum. One week after the operation, chest tightness occurred, the pacemaker interrogation found that the ventricular electrode was not pacing, and echocardiography suggested that the right ventricular electrode was perforating the pericardium. With the guidance of Digital Substraction Angiography(DSA)and echocardiography, the patients' symptoms were relieved after surgical removal of the right ventricular electrode slowly. One week after operation, no pericardial effusion was found, and cardiac function was normal. Conclusion This case emphasizes the importance of meticulous technology in the process of electrode adjustment/removal in patients with right ventricular myocardial perforation caused by pacemaker electrode. Also, multidisciplinary joint diagnosis, as well as immediate and timely treatment of critically ill patients are vital.