Introduction
Cardiac device therapy, including pacemakers and defibrillators, are
becoming an integral part of the treatment of bradyarrhythmia,
tachyarrhythmia and advanced heart failure. An aging population,
increasing prevalence of cardiovascular disease, advances in device
therapy, and introduction of implantable heart rate-rhythm monitoring
devices have resulted in an exponential gross in therapeutic cardiac
device implantation worldwide. These devices improve the quality of life
and increase survival in many cases. However, device implantation is not
without risk, and long-term monitoring of patients with device therapy
is crucial to achieve benefit and to avoid potential immediate and
long-term complications.
Despite the multiple clinical scenarios in which permanent pacing is
considered, most management decisions regarding permanent pacemaker
implantation are driven by the association of symptoms with bradycardia.
Other common indications include sick sinus syndrome, high grade
atrioventricular block and tachycardia-bradycardia syndrome. It is not
uncommon that pacemaker therapy is considered for the treatment of
chronotropic incompetence, but it is rarely considered in patients with
cardio-inhibitory neurocardiogenic dysfunction.
Permanent transvenous pacing system leads are guided through the left
subclavian, cephalic, or axillary veins and eventually screwed into
place in the right ventricle. After placement, cardiac follow-up is
necessary to rule out inadvertent lead placement, thromboembolic events,
or other possible medical emergencies.
We are presenting an extremely rare case of a 53-year-old man with an
old, neglected, and misplaced right ventricular pacemaker lead, caused
by a series of unfortunate events involving lack of follow-up and
neglect of the recommended guidelines before, during, and after device
implantation.