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Delayed Cardiac Perforation Caused by Pacemaker Lead Dislodgement During Chiropractic Therapy
Kyu-Yong Ko1, Sung Eun Kim1, Ji-Won Hwang1
1Division of Cardiology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.
JACC. Case Reports
|July 25, 2025
Summary
Pacemaker lead dislodgement can cause delayed cardiac perforation due to mechanical stress from activities like rehabilitation. Patients need counseling on physical activity risks and early imaging for lead complications.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Cardiac perforation from pacemaker lead dislodgement is a rare, potentially fatal complication.
- While early dislodgement is common, delayed perforation can occur due to external mechanical forces.
Observation:
- An 83-year-old male pacemaker recipient presented with dyspnea and syncope.
- Chest radiography revealed right ventricular lead migration with perforation and echocardiography confirmed hemopericardium.
- Lead dislodgement was suspected to be linked to chiropractic therapy for shoulder rehabilitation.
Findings:
- Successful extraction of the dislodged lead.
- Repositioning of a new lead in the interventricular septum for left bundle branch pacing.
Implications:
- This case highlights the risk of delayed cardiac perforation from mechanical stress during rehabilitation.
- Emphasizes the need for patient education on physical activity risks and cautious lead placement.
- Multimodal imaging is crucial for early detection of pacemaker lead complications.
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