CTICasesVentricular pacemaker lead perforation without effusion
Imaging findings
Chest radiograph and CT scan show the right ventricular active fixation pacing lead has perforated through the RV free wall into the pericardial space. The patient had lead alarm firings but no hemopericardium or tamponade.
Key takeaways
RV lead perforation can be clinically silent or present solely as pacemaker malfunction (sensing/pacing failures). Even without hemopericardium, confirmation of lead migration beyond the epicardial fat on CT requires repositioning or replacement.
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