Delayed Right Ventricular Automatic Implantable Cardioverter Defibrillator (AICD) Lead Perforation Resulting in Cardiac Tamponade: A Case Study.

Automatic implantable cardioverter defibrillator (AICD) lead perforation is a rare but potentially life-threatening complication. AICD lead perforations are rare, occurring in approximately 0.1%-0.8% of patients, most commonly within 24 hours of the implantation. ICD lead perforations can be acute (within 24 hours of implantation), subacute (between day 1 and day 30), or delayed (>30 days postimplantation). Delayed lead perforations are rare compared to acute and subacute lead perforations and are not as well-studied because patients are often asymptomatic and are not diagnosed. Here, we report the case of a 44-year-old male who presented to the emergency department with pleuritic chest pain and dyspnea one-month status-post dual-chamber AICD. The patient demonstrated signs and symptoms of cardiac tamponade, which was confirmed with a 2D echocardiogram and computed tomography (CT) scans. Emergency pericardiocentesis was performed under general anesthesia, which restored hemodynamic stability. The right ventricular lead was repositioned and a pericardial drain was placed. The patient remained in the intensive care unit (ICU) for three days and was discharged to home on postoperative day 8.