[Progressive cardiac tamponade and right ventricular free wall perforation as complications after dual-chamber pacemaker implantation - a case report].

In recent years the number of complications related to implantation of cardiac stimulating systems is increasing. Life-threatening myocardial perforation leading to cardiac tamponade is one of the rarest complications. In that case it is necessary to take the immediate lifesaving procedures. 61-year-old woman ended up in the cardiac surgery department with progressive cardiac tamponade and cardiogenic shock symptoms. Three weeks earlier due to the tachycardia-bradycardia syndrome with second-degree atrioventricular block diagnosis, the cardiac stimulating system was implanted into the heart at the cardiology department. Two days after the discharge from hospital the patient appeared in the emergency department with non-specific chest symptoms, which disappeared after analgesic drugs. After another two weeks the patient returned to the emergency department in general poor condition. Echocardiographic examination showed fluid in both pleural cavities, a dense layer around heart and fluid out wards from the layer in the pericardial space. Furthermore, CT scan showed unobvious shape crossing the heart muscle. Firstly, the patient was admitted to the cardiology department and next transferred to the cardio surgery where on account of deteriorating condition was made a decision urgent sternotomy and revision pericardial sac. Intraoperatively were found perforation of right ventricular free wall caused by stimulation electrode and hole communicating pericardial space with left pleural cavity. The operation went well, without any complications. The patient was discharged from hospital 12 days after surgery. In the case of suspected complications related to the implantation of electrostimulation equipment, it is necessary to perform appropriate diagnostics and implement urgent procedures, including surgery.

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