Contralateral pneumothorax after endocardial dual-chamber pacemaker implantation resulting from atrial lead perforation

We describe the occurrence of a right-sided pneumothorax following a left-sided dual chamber pacemaker implantation, due to a perforation of the screw of the J-shaped active-fixation lead through the right atrial wall. A review of the literature regarding complications of different atrial lead types (passive vs. active and J-shape vs. straight) is provided. Current data suggest that passive-fixation leads could have an advantage, provided they can be positioned satisfactorily because of the lower risk of pericardial complications. If active-fixation leads are used, straight leads might be preferable above J-shaped leads because of the lower rate of perforation.