Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2023; 11(7): 1615-1626
Published online Mar 6, 2023. doi: 10.12998/wjcc.v11.i7.1615
Bow-and-arrow sign on point-of-care ultrasound for diagnosis of pacemaker lead-induced heart perforation: A case report and literature review
Ni Chen, Guang-Xian Miao, Liang-Qin Peng, Yun-Hang Li, Juan Gu, Ying He, Tao Chen, Xiao-Yun Fu, Zhou-Xiong Xing
Ni Chen, Ying He, Tao Chen, Xiao-Yun Fu, Zhou-Xiong Xing, Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Guang-Xian Miao, Liang-Qin Peng, Department of Ultrasound, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Yun-Hang Li, Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Juan Gu, Department of Pharmacy, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Chen N was the attending physician for the patient, reviewed the literature, and contributed to manuscript drafting; Miao GX and Peng LQ performed the bedside ultrasound, interpreted the imaging findings, and contributed to manuscript drafting; Li YH, Gu J, and He Y summarized the clinical features and drafted the manuscript; Chen T and Fu XY helped draft the manuscript and review the literature; Xing ZX helped review the literature and made important contributions to the manuscript; All authors have approved the final version of the manuscript.
Supported by Foundation of Guizhou Science and Technology Department, No. QIANKEHEZHICHEN[2022]YIBAN179; National Natural Science Foundation of China, No. 82160370; and Guizhou Education Department, No. Qian Jiao He KY Zi[2018]239.
Informed consent statement: Informed written consent was obtained from the patient’s son for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhou-Xiong Xing, Doctor, MD, Chief Physician, Researcher, Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi 563000, Guizhou Province, China. xingzhouxiong111@126.com
Received: November 24, 2022
Peer-review started: November 24, 2022
First decision: December 13, 2022
Revised: December 17, 2022
Accepted: February 10, 2023
Article in press: February 10, 2023
Published online: March 6, 2023
Processing time: 97 Days and 23.1 Hours
Core Tip

Core Tip: Pacemaker lead-induced heart perforation is a rare but life-threatening complication of pacemaker implantation. Further, timely diagnosis remains a challenge for clinicians. Here, we report a novel case of right ventricular apex perforation by pacemaker lead associated with pericardial tamponade, which was rapidly diagnosed by a unique “bow-and-arrow” sign on point-of-care ultrasound (POCUS). We also propose a step-wise diagnostic approach using POCUS to enhance diagnostic speed and accuracy for lead-induced heart perforation. This step-wise ultrasonographic approach and the “bow-and-arrow” sign on POCUS are helpful for rapid diagnosis of lead perforation.