[Incomplete pacemaker lead fracture revealed by superficial maneuvers]

Area of Science:

• Cardiology
• Biomedical Engineering

Background:

• Dual-chamber pacemakers are crucial for managing bradyarrhythmias like complete atrioventricular block.
• Pacemaker lead complications can manifest years after implantation, affecting device function.

Observation:

• A 75-year-old male experienced recurrent syncope 7 years post-pacemaker implantation.
• Diagnostic evaluations, including ECG, X-ray, and pacemaker interrogation, initially showed no abnormalities.
• Holter monitoring revealed intermittent failure to pace, triggered by superficial skin maneuvers.

Findings:

• The patient's symptoms were linked to a significant increase in ventricular lead impedance during pacing.
• This impedance rise led to intermittent pacing failure, causing syncope episodes.
• No lead fracture or hardware dysfunction was identified on initial imaging or interrogation.

Implications:

• This case highlights the importance of considering lead impedance issues in pacemaker patients with unexplained syncope.
• Intermittent lead problems can occur without obvious hardware failure, necessitating thorough diagnostic investigation.
• Successful management involved replacing the malfunctioning ventricular lead, resolving symptoms and ensuring effective cardiac pacing.