Perforation of Left Ventricular wall and Ipsilateral Pleura by a Right Ventricular Pacemaker lead: Case Report

Introduction: Malposition of pacemaker lead is uncommon event and it usually regard the right ventricle. In rare cases, the perforation can involve the left ventricle and this is a potentially life-threatening complication. Case presentation: We described a case of both septum and LV free wall perforation by an RV pacemaker lead in an 84-year-old woman. Perforation also resulted in left pneumothorax and she became symptomatic. She also had pericardial effusion, so she underwent cardiac surgery to repair the bleeding lesion. As the swab for Covid-Sars 2 was positive, we had to wait for the negativization for the replacement of the ventricular lead. Conclusions: early identification is mandatory to prevent this complication and transvenous lead extraction with cardiac surgery backup should be considered.