Pacemaker lead migration

Case contributed by Ashesh Ishwarlal Ranchod


Placement of a new dual chamber cardiac pacemaker two weeks ago and new onset of focal muscle twitching.

Patient Data

Age: 60 years
Gender: Female
  • dual chamber cardiac pacemaker with left subclavian access in situ

  • dislodgement and retraction of the non-fragmented right ventricular pacemaker lead which appears coiled around the implantable pulse generator with an additional loop directly with the tip in projection of the mid-clavicular line in the left subclavian/axillary vein

  • the right atrial pacemaker lead appears in place

  • enlarged cardiac silhouette and prominent pulmonary vasculature indicating congestion

Case Discussion

The five common complications of pacemaker and cardiac resynchronization devices include hematoma, lead dislodgement, infection, lead perforation and dysrhythmias 1,2.

This is an example of lead dislodgement and extracardiac retraction of the right ventricular lead. Lead dislodgement most commonly occurs within the first three months of implantation and most commonly occurs in patients over 75 years of age 2. In this instance, there is a redundant lead wrapped around the pacemaker pulse generator device due to ongoing manipulation of the pulse generator in its subcutaneous pocket – this might be due to either reel syndrome or the ratchet mechanism or a combination of the two which is difficult to determine in this case by chest x-ray alone 3-5.

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