Subcutaneous Implantable Cardioverter-Defibrillator Lead Dislodgement Masquerading as Left Shoulder Pain.

Area of Science:

• Cardiology
• Medical Devices
• Surgical Complications

Background:

• Implantable cardioverter-defibrillators (ICDs) are crucial for preventing sudden cardiac death.
• Subcutaneous ICDs (S-ICDs) offer an alternative to transvenous systems with fewer complications.
• However, S-ICD complications, though rare, can occur and require prompt recognition.

Observation:

• A patient presented with shoulder pain and swelling weeks after S-ICD implantation.
• Initial diagnosis considered musculoskeletal injury, but chest radiography revealed lead displacement.
• The S-ICD lead had migrated and traversed the splenic flexure of the colon.

Findings:

• The case illustrates a rare but serious complication of S-ICD lead migration.
• Multidisciplinary care involving cardiology, surgery, and infectious disease was essential for management.
• Successful management included S-ICD removal, surgical intervention, antibiotics, and eventual reimplantation.

Implications:

• This case underscores the importance of considering device-related complications in patients with S-ICDs.
• It highlights the need for vigilance and advanced imaging to diagnose lead displacement.
• Effective management requires a coordinated, multidisciplinary approach to ensure patient safety and optimal outcomes.