{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:12:56Z","timestamp":1788415976455,"version":"build-2803163510"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Permanent pacemaker implantation via subclavian vein puncture may induce rare but life-threatening iatrogenic vascular injury. Vascular perforation with pacing lead penetration-exit-re-entry trajectory accompanied by normal intraoperative pacing parameters is reported extremely rarely, which greatly increases the risk of missed diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 70-year-old female patient with complete atrioventricular block received dual-chamber pacemaker implantation. All intraoperative lead electrical indicators were within normal range. Immediately after the operation, she rapidly developed massive hemothorax and hemorrhagic shock with severe hypoxemia. A thoracoscopic exploration verified a unique \u201cpenetration-exit-re-entry\u201d lesion: the pacing electrode penetrated the left subclavian vein wall, exited the vascular lumen, and re-entered the innominate vein, resulting in persistent intrathoracic bleeding. After emergency thoracic drainage, surgical venous repair and blood transfusion resuscitation, the patient's vital signs gradually stabilized and fully recovered. A 1-month follow-up showed stable pacemaker function without adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that normal intraoperative pacing parameters cannot rule out occult extravascular lead perforation and venous laceration. Operators should maintain high vigilance for unexplained perioperative hemodynamic collapse. Combined imaging, diagnostic thoracentesis, and early thoracoscopic surgical intervention are the core rescue strategies for this fatal complication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1943190","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:17:47Z","timestamp":1788412667000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Electrode perforation with normal pacemaker parameters leading to hemorrhagic shock: a rare case report of the \u201cpenetration-exit-re-entry\u201d phenomenon"],"prefix":"10.3389","volume":"13","author":[{"given":"Zuoan","family":"Qin","sequence":"first","affiliation":[{"name":"Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiac Catheterization Laboratory, Changde Hospital, Xiangya School of Medicine, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Chest Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Chest Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"83","DOI":"10.2147\/JMDH.S489600","article-title":"Types of complications and associated factors in patients undergoing permanent cardiac pacemaker implantation: a systematic 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