Introduction
Cardiac device therapy, including pacemakers and defibrillators, are becoming an integral part of the treatment of bradyarrhythmia, tachyarrhythmia and advanced heart failure. An aging population, increasing prevalence of cardiovascular disease, advances in device therapy, and introduction of implantable heart rate-rhythm monitoring devices have resulted in an exponential gross in therapeutic cardiac device implantation worldwide. These devices improve the quality of life and increase survival in many cases. However, device implantation is not without risk, and long-term monitoring of patients with device therapy is crucial to achieve benefit and to avoid potential immediate and long-term complications.
Despite the multiple clinical scenarios in which permanent pacing is considered, most management decisions regarding permanent pacemaker implantation are driven by the association of symptoms with bradycardia. Other common indications include sick sinus syndrome, high grade atrioventricular block and tachycardia-bradycardia syndrome. It is not uncommon that pacemaker therapy is considered for the treatment of chronotropic incompetence, but it is rarely considered in patients with cardio-inhibitory neurocardiogenic dysfunction.
Permanent transvenous pacing system leads are guided through the left subclavian, cephalic, or axillary veins and eventually screwed into place in the right ventricle. After placement, cardiac follow-up is necessary to rule out inadvertent lead placement, thromboembolic events, or other possible medical emergencies.
We are presenting an extremely rare case of a 53-year-old man with an old, neglected, and misplaced right ventricular pacemaker lead, caused by a series of unfortunate events involving lack of follow-up and neglect of the recommended guidelines before, during, and after device implantation.