Cough, a rare and not well recognized symptom of lead perforation

A 64-year-old woman was admitted to our department for dual-chamber pacemaker implantation. No complication apparently occurred during the procedure. An active fi xation ventricular lead was positioned in right ventricular septal apex. Soon after implantation the patient started to suffer from non-productive cough, clearly related to ventricular stimulation. Transthoracic echocardiography revealed a small pericardial effusion along the apical segments. The patient underwent urgent contrast chest CT confi rming pericardial effusion, and showing an intramyocardium placement of the right ventricular apical lead. Due to persistence of symptoms, we decided to perform right ventricular lead repositioning in right middle septum. Post-procedure, cough abruptly disappeared.