Complications of retained cardiac defibrillator coil left in situ

A 42-year-old man presented to a regional hospital emergency department with a 4-day history of haemoptysis, shortness of breath, pleuritic chest pain, productive cough and subjective fevers. This episode was the third similar presentation in a 2-month period. The patient was known to have dilated cardiomyopathy secondary to amphetamine use and had previously required insertion of automated implantable cardiac defibrillator (AICD). Due to recurrent complications, the AICD had been replaced on two occasions and a superior vena cava (SVC) lead left in situ on its final removal. Clinical examination and investigations revealed lower respiratory tract infection and transthoracic echocardiogram revealed severe left ventricular failure with an ejection fraction of 16%. The patient was admitted under the general medical team for treatment and investigation of suspected bacteraemia and septicaemia secondary to colonisation of the retained AICD lead. He spent 6 days as an in-patient and was discharged on home where he was to be followed up by the advanced heart failure team in a tertiary centre for consideration of new AICD insertion and to explore possibility of retained coil removal. This case report discusses the concerns surrounding retained SVC leads and potential clinical sequalae. As this patient presented three times within a period of 2 months, it was suspected retained SVC lead was a predisposing factor for recurrent lower respiratory infection.