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 lifethreatening 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 wellstudied because patients are often asymptomatic and are not diagnosed. Here, we report the case of a 44year-old male who presented to the emergency department with pleuritic chest pain and dyspnea onemonth 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.