Traumatic Fracture of Pacemaker Lead by Suture Transfixation to Pectoral Muscle

J INVASIVE CARDIOL 2018;30(12):E156.

Key words: cardiac imaging, lead fracture, pacemaker implantation

A 75-year-old woman underwent dual-chamber permanent pacemaker implantation in view of recurrent presyncope and excessive fatigue secondary to complete heart block. An active ventricular lead was placed at the right ventricular apex and screwed in after good pacing parameters were achieved. The lead was transfixed by suturing the sleeve to the pectoral muscle. To our surprise, there was a significant rise in lead threshold. A lead dislodgment while suturing the sleeve was suspected. However, on fluoroscopic examination the lead was adequately positioned, but a lead fracture was apparent at the suturing site (Figures 1 and 2). The lead was replaced with a new lead and the procedure was successfully completed without any complications. 

Fractures of pacemaker leads are well reported, with the most common site near the subclavian vein entry site due to entrapment between the clavicle and first rib. Direct trauma and excessive movement of the upper limb are common causes. To the best of our knowledge, acute lead fracture during pacemaker implantation has not been reported. Suturing the lead without the sleeve might damage the lead. However, in the present case, this important precaution was carefully taken. Significant lead damage was immediately detected in this case, which led to rectification of the problem. Minor trauma to the lead at this important step may affect the lead outcome in the long term. Tying knots tightly but not too vigorously is suggested, as this carries potential to damage the lead.

From the ¹Department of Cardiology, Max Super Speciality Hospital; ²Cath Lab, Max Heart and Vascular Institute; and ³Department of Cardiology, Max Healthcare Institute Ltd, Saket, New Delhi, India.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted July 17, 2018. 

Address for correspondence: Raghav Bansal, MD, DM, Cardiology, Associate Consultant Cardiology, Max Super Specialty Hospital Saket, Press Enclave Road, Mandir Marg, Saket, New Delhi, Delhi 110017, India. Email: raghav.mamc@gmail.com