{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:50:43Z","timestamp":1756385443075,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,9,24]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2018-226318","type":"journal-article","created":{"date-parts":[[2018,10,26]],"date-time":"2018-10-26T04:53:00Z","timestamp":1540529580000},"page":"bcr-2018-226318","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Chest pain following permanent pacemaker insertion\u2026 a case of pneumopericardium due to atrial lead perforation"],"prefix":"10.1136","volume":"2018","author":[{"given":"Suleman","family":"Aktaa","sequence":"first","affiliation":[{"name":"Department of Cardiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, West Yorkshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavi","family":"Fatania","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, West Yorkshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Gains","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, West Yorkshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hazel","family":"White","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, West Yorkshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,10,25]]},"reference":[{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.1","unstructured":"The 11th annual report for the National Cardiac Rhythm Management Devices Audit, April 2015 \u2013 March 2016, published on 14th February, 2017. http:\/\/www.ucl.ac.uk\/nicor\/audits\/cardiacrhythm\/documents\/annual-reports\/crm-devicesnational-audit-report-2015-16_v2."},{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-301853"},{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.3","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCULATIONAHA.113.003747","article-title":"Temporal trends in quality of care among recipients of implantable cardioverter-defibrillators: insights from the National Cardiovascular Data Registry","volume":"129","author":"Dodson","year":"2014","journal-title":"Circulation"},{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2015.02.025"},{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.5","first-page":"862","article-title":"[Retrospective analysis on the clinical features and management of acute and subacute right ventricular perforation by pacemaker lead]","volume":"41","author":"Dai","year":"2013","journal-title":"Zhonghua Xin Xue Guan Bing Za Zhi"},{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000299"},{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.7","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.joa.2017.03.003","article-title":"Subacute pneumothorax contralateral to the venous access site associated with atrial lead perforation in a patient who was receiving corticosteroid therapy","volume":"33","author":"Ishizue","year":"2017","journal-title":"J Arrhythm"},{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.8","doi-asserted-by":"publisher","DOI":"10.1016\/S1099-5129(03)00079-5"},{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.9","doi-asserted-by":"publisher","DOI":"10.1016\/S1099-5129(03)00093-X"},{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.10","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1111\/j.1540-8159.2007.00575.x","article-title":"Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT","volume":"30","author":"Hirschl","year":"2007","journal-title":"Pacing Clin Electrophysiol"},{"key":"2025082700264298000_2018.oct25_1.bcr-2018-226318.11","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eun363"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-226318","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:26:53Z","timestamp":1756279613000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-226318"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,25]]},"references-count":11,"alternative-id":["10.1136\/bcr-2018-226318"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-226318","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,10,25]]}}}