Multiple pacemaker lead breakages due to clavicle dislocation following clavicle fracture

Area of Science:

• Cardiology
• Medical Device Technology
• Orthopedics

Background:

• Cardiac resynchronization therapy (CRT) with defibrillator implantation is a common procedure for heart failure management.
• Implanted device leads are susceptible to mechanical stress and damage, particularly in the upper body.
• Fractures and dislocations near implanted devices can pose unique challenges to device integrity.

Purpose of the Study:

• To investigate the impact of distal clavicle dislocation on cardiac resynchronization therapy with defibrillator (CRT-D) device leads.
• To understand the mechanism by which clavicle dislocation may lead to device lead damage.
• To highlight potential complications of orthopedic injuries in patients with implanted cardiac devices.

Main Methods:

• Case report of a 58-year-old male patient with a CRT-D device.
• Documentation of a right clavicle fracture and subsequent distal clavicle dislocation.
• Serial radiographic analysis to assess lead integrity and device position relative to the dislocated clavicle.

Main Results:

• Dislocation of the distal clavicle occurred 2 months post-fracture.
• Significant changes in lead parameters were observed following clavicle dislocation.
• Radiographic evidence suggested compression of device leads by the dislocated distal clavicle in specific upper limb positions.

Conclusions:

• Distal clavicle dislocation can compromise the integrity of CRT-D device leads.
• Mechanical compression from the dislocated clavicle, exacerbated by upper limb movements, is a likely cause of lead damage and breakage.
• Close monitoring and consideration of orthopedic injury complications are crucial in patients with implanted cardiac devices.