Displaced pacing lead

Case contributed by Dr Paul Simkin

Presentation

Syncope

Patient Data

Age: 80
Gender: Male
X-ray

Comparison made to the x-ray from 3 months earlier.

Since the previous x-ray one of the leads from the left chest wall dual lead cardiac device has become retracted to the level of the subclavian vein. This was originally thought to be within the coronary sinus.

Even allowing for the AP projection the heart is enlarged. Mild pulmonary edema. Blunting of the left costophrenic recess is unchanged from x-ray dated 25 February, 2014, and may represent pleural effusion or pleural thickening.

X-ray

Comparison study, 3 months prior and immediately following pacemaker insertion.

Case Discussion

Displaced or fractured leads often leads to dysfunction of the pacing device/defibrillator, such as in this case where the patient presented with syncope.

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