Implantation of pacemaker is a minimally invasive surgical method in patients with heart conditions. Complications during and after implantation are not rare. (1) Department of Cardiology at the Clinical Hospital „Sveti Duh“ implants single chamber, dual chamber, implantable cardioverter defibrillator and cardiac resynchronization therapy devices. Implantation is done following current guidelines and good practice standards. In our institution we have encountered certain complications during procedures, which mostly included pneumothorax and chronic occlusion of the subclavian vein. Rare complications included subacute perforation of the right ventricle and perioperative myocardial infarction.

As a complication, pneumothorax usually occurs during procedure, however patient’s condition can worsen as the procedure advances. If possible, the procedure is finalized and if the patient condition is worsening or he develops respiratory difficulties, he is transferred to Coronary Care Unit, chest X-ray is done to prove the complication and the patient is treated until symptoms resolve. Chronic occlusion of subclavian vein makes pacemaker lead placement impossible. It is diagnosed using intravenous contrast and, following that, the opposite side is chosen for the approach. Subacute perforation of the right ventricle is characterized with worsening of the chest pain during procedure, is diagnosed with an echocardiography exam, and the patient is transferred to the Coronary Care Unit. If the patient’s condition worsens, the patient is transferred to the Cardiac Surgery Department. Periprocedural myocardial infarction is usually seen in elderly patients.

The most common complication after procedure is displacement of pacemaker leads and, less often, infections. Dislocation of the atrial or ventricular leads demands surgical revision during which displaced leads are repositioned or new leads are placed, while previous, displaced leads are isolated if they cannot be removed. Infections are reduced to the absolute minimum by prophylactic administration of antibiotics, and wound aspirate is taken during procedure and sent to the microbiology lab.