Biphasic pericardial effusion following the implantation of a pacemaker

The case is reported of a patient who developed pericardial effusion, both early, at 24 hours, and late, at 3 weeks, after the implantation of a pacemaker. The late effusion was accompanied by manifestations of pericarditis. Pericarditis occurring a few weeks after the insertion of a pacemaker is a variant of the post-cardiac injury syndrome (PCIS). This form of pericarditis, which is considered to be autoimmune in origin, was originally described following myocardial infarction and cardiac surgery. In these conditions the incidence of the PCIS is increased among patients with an early pericardial reaction, which is considered traumatic in origin and occurs from hours to a few days after the precipitating event. Although both early and late forms of pericarditis have been documented following the insertion of a pacemaker, no report was found of early and late pericardial reaction occurring sequentially in the same patient. The course of this patient supports the hypothesis that, in agreement with the other forms of the PCIS, there may be a connection between the early and late forms of pericardial reaction following the implantation of a pacemaker.