Double Whammy: A case report of two iatrogenic cardiac perforations in the same patient

Cardiac perforation is an uncommon but potentially fatal complication of pacemaker lead placement and pericardiocentesis. We report the case of a 61-year-old woman who sustained two distinct iatrogenic right ventricular perforations, the first following temporary endocavitary pacemaker (TPM) insertion and the second during rescue echocardiography-guided pericardiocentesis performed for cardiac tamponade after initially presented with symptomatic bradycardia secondary to complete heart block. Emergency surgery via median sternotomy revealed both perforations, which were repaired with pledgeted sutures. Her postoperative recovery was uneventful, and a permanent pacemaker was implanted prior to discharge. This case highlights the rare occurrence of sequential iatrogenic cardiac perforations in a single patient and underscores the importance of vigilance, timely recognition of pacing complications, and multidisciplinary management to prevent fatal outcomes.