Pacemaker lead fracture

Case contributed by Daniel J Bell

Presentation

Incidental finding

Patient Data

Age: 90 years
Gender: Male
x_ray

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. 

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