Key result
A 77-year-old male experienced a rare late pacemaker lead insulation break more than 3 years after implantation, likely due to lead entrapment in the medial subclavicular musculotendinous complex.
Case Report (n=1)
Highlights the medial subclavicular musculotendinous complex as a potential cause of late pacemaker lead insulation break due to compressive damage.
May warrant consideration of subclavicular entrapment in late lead insulation breaks; hypothesis-generating, requiring prospective validation.
Insulation break in a permanent pacemaker lead is a rare long-term complication. We describe an elderly male with a VVIR pacemaker, who presented with an episode of presyncope more than 3 years after the initial implantation procedure, attributed to insulation break possibly caused by lead entrapment in components of the medial subclavicular musculotendinous complex (MSMC) and repeated compressive damage over time during ipsilateral arm movement requiring lead replacement. The differential diagnosis of a clinical presentation when pacing stimuli are present with failure to capture and the role of the MSMC in causing lead damage late after implantation are discussed.
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Bhattacharyya et al. (2015) conducted a case report in Pacemaker lead malfunction (insulation break) (n=1). Standard subclavian puncture technique was evaluated on Lead insulation break. A 77-year-old male experienced a rare late pacemaker lead insulation break more than 3 years after implantation, likely due to lead entrapment in the medial subclavicular musculotendinous complex.
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