CASE REPORT article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1587204
Acute Pulmonary Embolism Following Dual-Chamber Pacemaker Implantation: A Case Report
Provisionally accepted
- 1The Third People’s Hospital of Datong, Datong, Shanxi Province, China
- 2Shanxi Cardiovascular Disease Hospital, Taiyuan, Shanxi Province, China
- 3General Hospital of Shanxi Datong Tongmei Group, Datong, Shanxi Province, China
- 4The Fifth People's Hospital of Datong, Datong, China
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Acute pulmonary embolism (APE), a critical complication following permanent pacemaker implantation, presents profound therapeutic challenges when occurring during the early postoperative phase. We report a 73-year-old female who developed high-risk APE with cardiogenic shock 47 hours after dual-chamber pacemaker implantation via the right subclavian vein. The immobilization of the affected upper limb and bed rest, along with endothelial injury during the implantation process, can trigger an inflammatory response and activate the coagulation cascade, ultimately leading to a pro-coagulant state, which may subsequently induce deep vein thrombosis in the lower extremities and subsequent bilateral pulmonary embolism(1, 2). Despite adhering to 2019 ESC guidelines for high-risk APE management-prompt intravenous thrombolysis with alteplase (50 mg) stabilized hemodynamics-the intervention triggered pacemaker pocket hemorrhage. Strategic intermittent elastic compression bandaging mitigated hematoma progression without compromising wound healing. Anticoagulation with warfarin (INR 2-3) and serial imaging confirmed resolution of thromboembolic burden and right atrial remodeling. This case underscores the delicate balance between life-saving reperfusion and device-related complications in pacemaker recipients, advocating for tailored hemostatic strategies in high-risk cohorts.
Keywords: Acute pulmonary embolism, Dual-chamber pacemaker, intravenousthrombolysis, Pocket hematoma, Cardiogenic shock
Received: 04 Mar 2025; Accepted: 26 Sep 2025.
Copyright: © 2025 Zhizhou, Zhang, Wang, Hao, Ma, Liu, Wu and Huo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yuehong Huo, 272970081@qq.com
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