Presentation
Incidental finding
Patient Data
Fracture of the proximal right atrial lead of the left chest cardiac pacemaker. Right ventricular lead is intact.
Case Discussion
Lead fractures in permanent cardiac pacemakers are seen in 1-4% patients. Commonly the fractures occur lateral - and close - to their entry site into the subclavian vein. The usual mechanisms are consequential to:
- squeezing of the lead in the middle of the clavicle and first rib
and/or
- trapping of the lead in the costoclavicular space by encasing soft tissue
Often fractures are triggered by physical exertion using the upper limbs, e.g. weightlifting, or by trauma in this location. It is common practice to advise patients with implanted devices to avoid such activities.
Lead fractures need not be complete. In some cases it is only partial and symptoms only manifest when the arm is in certain positions resulting in a loss of electrical contact as the partially split leads ends come away from each other 2.
Lead fractures tend to present acutely when patients are dependent on their pacemakers, e.g. pacing for complete heart block.