Clinical case of intracardiac pacemaker lead fracture

Lead fracture is a serious complication of a pacemaker; its prevalence is 0.1–4.2%. The common site of lead fracture is at the space between the clavicle and the first rib. The causes are intense physical activity, which approximates the clavicle to the rib and compression of the lead, chest trauma, anatomical features, twiddler’s syndrome. Diagnosis of lead fracture is can be made by electrocardiography — there is a transient or permanent stimulation/sensitivity disturbance. When the programmer interrogates the pacemaker, a significant sign is an abrupt rise in the lead impedance, although cases of fracture with normal impedance values have been reported. The article presents an extremely rare clinical case of an intracardiac lead fracture in a 28-year-old patient. At the initial implantation, leads were passed through the accessory left superior vena cava, resulting in a loop in the right ventricle. The patient himself was subjected to increased physical activity. The question of the need to remove such leads remains open. Some authors note that the distal end is firmly fixed to the heart wall, and therefore does not expose the patient to a vital risk. Others consider that the lead can become a source of thrombus formation, or fragmentation with embolism in the pulmonary circulation can occur. In our case, the causes of the fracture were probably an intense physical activity and bending of the lead inside the right ventricle. The clinical situation was discussed with cardiac surgeons of the federal centers of cardiovascular surgery. Given the high risks of open-heart surgery, it was deci¬ded to refrain from removing the broken lead, and the patient was provided with atrial pacing.