Key result
LMNA cardiomyopathy case highlights rare sequential ICD lead transfixion and inadvertent LV placement.
Why the study?
LMNA-related dilated cardiomyopathy often requires ICD implantation, but rare lead-related complications can occur and need detailed characterization.
Case Report (n=1)
This case highlights the importance of systematic troubleshooting and the use of multimodality imaging (cardiac CT, transesophageal echocardiography) to identify and manage rare lead complications and altered anatomy during ICD implantation.
Alerts clinicians to rare sequential ICD lead complications in LMNA cardiomyopathy; case report leaves open optimal placement strategies and incidence.
BACKGROUND: LMNA-related dilated cardiomyopathy is associated with ventricular remodeling and a high arrhythmic risk, frequently requiring implantable cardioverter-defibrillator (ICD) implantation. Although transvenous systems are generally safe, rare lead-related complications may occur. CASE SUMMARY: We report a 51-year-old man with LMNA-related dilated cardiomyopathy who experienced 2 rare and sequential ICD lead complications. An initially septal right-ventricular lead was complicated by myocardial transfixion because of anterior apical positioning, revealed by cardiac computed tomography after a rise in pacing thresholds. During reintervention, a second lead was implanted but was later found to have traversed an unrecognized sinus venosus atrial septal defect with partial anomalous pulmonary venous return, resulting in inadvertent left-ventricular lead placement. The lead was successfully repositioned under transesophageal echocardiographic guidance. Three-dimensional computed tomography reconstruction clearly demonstrated both abnormal lead positions. DISCUSSION AND TAKE-HOME MESSAGE: This case highlights the importance of systematic troubleshooting, awareness of altered anatomy, and multimodality imaging during ICD implantation.
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Laporte et al. (2026) conducted a case report in LMNA-related dilated cardiomyopathy (n=1). Implantable cardioverter-defibrillator (ICD) implantation was evaluated. A 51-year-old man with LMNA cardiomyopathy experienced 2 rare sequential ICD lead complications, including myocardial transfixion and inadvertent LV placement via an unrecognized atrial septal defect.
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