Acute Cardiac Tamponade Caused by Right Ventricular Perforation After Temporary Transvenous Pacing

Background: Although temporary transvenous pacing is a lifesaving therapy for symptomatic complete heart block, the procedure may also lead to serious complications such as right ventricular perforation and acute cardiac tamponade. Case Summary: A 76-year-old woman with ischemic heart disease developed symptomatic complete atrioventricular block and severe bradycardia. A temporary transvenous pacemaker was inserted through the right femoral vein with the lead positioned at the right ventricular apex. Within 15 minutes, the patient experienced hypotension, decreased consciousness, and pacing dysfunction. Bedside echocardiography revealed a large pericardial effusion consistent with acute cardiac tamponade. Pericardiocentesis was ineffective owing to clotted hemopericardium, prompting emergency surgery that confirmed right ventricular perforation and allowed successful repair. Discussion: This case demonstrates that temporary transvenous pacing, though routine, carries a risk of serious iatrogenic complications in elderly patients. Take-Home Message: Acute hypotension after temporary pacing should prompt immediate evaluation for cardiac tamponade; early diagnosis and timely surgery are essential to improving outcomes.