Positional syncope occurring just at the right time in a patient with a permanent pacemaker: A case report

Area of Science:

• Cardiology
• Medical Devices
• Neurology

Background:

• Pacemaker implantation is a common procedure for managing cardiac arrhythmias.
• Subclavian crush syndrome is a known complication of pacemaker lead placement.
• Positional syncope can have various underlying causes, requiring thorough investigation.

Observation:

• An unusual case of positional syncope presented years after pacemaker implantation.
• The syncope was attributed to a fractured pacemaker lead.
• The lead fracture was a consequence of subclavian crush syndrome.

Findings:

• Integrated diagnostic approach including history, examination, device interrogation, and radiography confirmed the lead fracture.
• The fractured lead was identified as the cause of the patient's recurrent syncope.
• Pacemaker lead fracture can manifest as positional syncope long after implantation.

Implications:

• Highlights the importance of considering device-related complications in late-onset syncope.
• Emphasizes the utility of a comprehensive diagnostic strategy for device-related syncope.
• Successful lead and device revision can effectively manage syncope caused by pacemaker lead fractures.