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. 2024 May;8(2):107-110.
doi: 10.5811/cpcem.1466.

Defibrillator Lead Perforation Leading to Concerning Electrocardiogram Findings: Case Report

Bryan Rosenberg  1 , Max Hockstein  1 , Cyrus Hadadi  2
Affiliations

Defibrillator Lead Perforation Leading to Concerning Electrocardiogram Findings: Case Report

Bryan Rosenberg et al. Clin Pract Cases Emerg Med. 2024 May.

Abstract

Introduction: Implantable cardioverter-defibrillator (ICD) lead perforation through the myocardium may result in chest pain and electrocardiogram (ECG) changes concerning for ST-segment elevation myocardial infarction. The clinical context of the ECG aids in appropriate management.

Case report: We report the case of a 71-year-old woman experiencing chest pain after an ICD placement two weeks earlier. On presentation, she exhibited ST-segment elevation on her ECG. Computed tomography confirmed ICD lead migration. The patient's hemodynamics were normal, and she was discharged home after a five-day hospital stay following a lead revision.

Conclusion: Although rare, ICD lead perforation is a potential cause of chest pain and ischemic ECG changes. Emergency physicians should consider lead perforation as a potential differential diagnosis when evaluating chest pain in patients with ICDs, taking into account the potential complications of coronary angiography.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1.
Image 1.
Initial electrocardiogram on presentation to the emergency department showing ST-segment elevations (arrows) across the precordial and high lateral leads.
Image 2.
Image 2.
Computed tomography chest showing the right ventricular lead tip perforating into the pericardiac fat (arrow).
Image 3.
Image 3.
Electrocardiogram showing resolution of ST-segment elevations after perforated pacer lead was successfully revised.
See this image and copyright information in PMC

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