Pacing lead inserted via the subclavian artery caused acute coronary syndrome

Introduction of a cardiac pacing lead via the subclavian artery is a rare complication in the process of pacemaker implantation. Removal of the lead from the arterial system imposes an increased risk of cerebral thrombembolism and, in case of arterial puncture, an increased risk of bleeding.

Here we describe an acute coronary syndrome caused by a pacing lead inserted via the subclavian artery with the tip implanted close to the ostium of the left coronary artery. We further describe the successful removal of the lead and give a short overview of the literature.

In cases where a pacemaker or ICD lead has already been placed in the left ventricle for an extended period of time and there is no indication for replacement like insufficient threshold levels, infection, or thrombembolic events, the lead can be left in place and the patient be treated with anticoagulants. In asymptomatic patients with additional indications for cardiac surgery simultaneous lead extraction should be considered. In patients with a history of thrombembolic events, or in patients with other indications for lead replacement, lead extraction should preferably be performed by cardiac surgery, rather than by percutaneous extraction.