Successful totally thoracoscopic management of a superior vena cava perforation with a pacemaker lead

Case report An 83-year-old man was an emergency referral to our institute from the heart rhythm department of another clinic. Fifteen days prior, he underwent atrioventricular pacemaker implantation (Medtronic Sensia DR; Medtronic Inc, Minneapolis, MN) because of sick sinus syndrome with active fixation of an atrial lead (Flextend 2, Model 4096; Boston Scientific, St Paul, MN) and passive fixation of a ventricular lead (Fineline II, Model 4457; Boston Scientific). The following day, the pacemaker control presented abnormal sensing and pacing parameters of the atrial lead; thus, repositioning of the lead was performed. Four days later, repositioning of both leads was required. Subsequently, the patient’s condition became stable, but he had a subfebrile temperature. Antibiotic therapy was performed without effect. Chest x-ray and transthoracic echocardiography showed right-side hemothorax. Pleural puncture was performed and 1000 mL of hemorrhagic liquid was removed. On the same day, the patient was emergently transferred to our clinic. On admission, the patient was hemodynamically stable. The pacemaker control presented normal sensing and pacing parameters of the ventricular lead and loss of atrium capture during maximum output pacing and diaphragm