Late Fracture of Stylet-driven Lead Intended for Conduction System Pacing 2 Years After Implant

Figures

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  Figure 1:. Electrocardiogram of baseline rhythm showing atrial fibrillation with right bundle branch block and slow ventricular rates.

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  Figure 2:. Electrocardiogram of paced morphology after lead implantation.

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  Figure 3:. Electrocardiogram of slow AF with right bundle branch block despite pacemaker implantation.

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  Figure 4:. Device check demonstrating sudden change in lead parameters including ventricular pacing threshold, R-wave sensing, and lead impedance.

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  Figure 5:. Initial chest X-ray after device implantation (A) and repeat chest X-ray at the time of syncope with fall 2 years later (B) demonstrating change in angulation of the distal lead between the ring electrode and lead tip electrode. The blue arrow shows initial angulation, with the orange arrow showing more acute angulation.

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  Figure 6:. Fluoroscopic imaging showing probable fracture between the tip and ring electrode.