An unusual presentation of implantable cardioverter-defibrillator lead perforation

Recently, there have been increased reports of implantable cardioverter-defibrillator (ICD) lead perforation. Controversy exists about the safety of certain leads.

A 37-year-old man with an ischemic cardiomyopathy presented four days postimplantation of an ICD lead with localized nonpleuritic chest wall pain. Imaging demonstrated proximity of the lead to the rib, suggestive of irritation of the periosteum. The lead was repositioned to the right ventricular septum without adverse effect on defibrillation.

Lead perforation presenting with focal chest pain due to rib irritation is unusual. Placement of ICD leads on the right ventricular septum should be considered to improve safety.