Brachial Plexus Injury Caused by Indwelling Axillary Venous Pacing Leads

A 64-year-old male patient underwent cardiac resynchronization therapy (CRT) device implantation via the axillary venous approach. Two weeks later, the patient started complaining of "electric shock-like" pain in the left axillary area. During physical examination, typical pain in the left axillary area was reproduced whenever his left shoulder was passively abducted more than 60 degrees. Fluoroscopic examination showed that the left ventricle (LV) and right atrium (RA) leads were positioned at an acute angle directing towards the left brachial plexus whenever the patient's shoulder was passively abducted. Brachial plexus irritation by the angulated CRT leads was strongly suspected. To relieve the acute angulation, we had to adjust the entry site of the LV and RA leads from the distal to the proximal axillary vein using the cut-down method. After successful lead repositioning, the neuropathic pain improved rapidly. Although transvenous pacing lead-induced nerve injury is not a frequent complication, this possibility should be kept in mind by the operators.