Bow-and-arrow sign on point-of-care ultrasound for diagnosis of pacemaker lead-induced heart perforation: A case report and literature review

Figure 2 Imaging manifestations on point-of-care ultrasound indicating pacemaker lead perforation of the right ventricle. A: Parasternal four-chamber view showing pericardial effusion and the outline of a pacemaker lead in the right ventricle (RV) chamber; B: Nonstandard apical RV view showing pericardial effusion and the lead with its tip penetrating the RV wall at the apex, producing a “bow-and-arrow” sign; C and D: Apical four-chamber view (C) and nonstandard apical RV view (D) focusing on the tip and showing the lead penetrating the apical wall and projecting into the free pericardial space. Yellow arrows denote pericardial effusion and orange arrows denote the pacemaker lead; RA: Right atrium; RV: Right ventricle; LA: Left atrium; LV: Left ventricle.