BMJ Case Reports 2018; doi:10.1136/bcr-2018-226318
  • Unusual association of diseases/symptoms

Chest pain following permanent pacemaker insertion… a case of pneumopericardium due to atrial lead perforation

Open Access
  1. Hazel White1
  1. 1Department of Cardiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, West Yorkshire, UK
  2. 2Department of Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, West Yorkshire, UK
  1. Correspondence to Dr Suleman Aktaa, suleman.aktaa{at}
  • Accepted 24 September 2018
  • Published 25 October 2018


Permanent pacemaker (PPM) implantation is an increasingly common procedure with complication rate estimated between 3% and 6%. Cardiac perforation by pacemaker lead(s) is rare, but a previous study has shown that it is probably an underdiagnosed complication. We are presenting a case of a patient who presented 5 days after PPM insertion with new-onset pleuritic chest pain. She had a normal chest X-ray (CXR), and acceptable pacing checks. However, a CT scan of the chest showed pneumopericardium and pneumothorax secondary to atrial lead perforation. The pain only settled by replacing the atrial lead. A repeat chest CT scan a few months later showed complete resolution of the pneumopericardium and pneumothorax. We believe that cardiac perforation can be easily missed if associated with normal CXR and acceptable pacing parameters. Unexplained chest pain following PPM insertion might be the only clue for such complication, although it might not always be present.


  • Contributors SA: second operator in the first procedure, reviewed patient during admission, wrote the case up. KF: performed the provisional report of the CT chest highlighting the findings. CG: reviewed the CT chest and finalized the report. HW: Responsible consultant for the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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