Recurrent Pulmonary Emboli Secondary to Right Atrial Thrombus Around a Permanent Pacing Catheter: A Case Report and Review of the Literature

A case report and review of the literature. This report describes the management of a woman with multiple pulmonary emboli secondary to a large right atrial clot which had formed around her permanent trans‐venous pacemaker. She continued to have pulmonary emboli despite adequate anti‐coagulation. Removal of the catheter and pacing required right atriotomy under cover of cardiopulmonary bypass, Additionally, eight English language case reports of symptomatic pericatheter thromboses are reviewed. In these cases, pericatheter clot resulted either in right‐sided inlet obstruction or pulmonary emboJi. The mortality rate was 75%. Although the cause for our patient's thromboembolic events is uncertain, congestive heart failure was a predisposing factor in 75% of the other reported cases. We suggest that pacemaker patients in congestive heart failure might benefit greatly from chronic anticoagulation.