Permanent pacemaker (PPM) malfunction due to electrical connection problems such as a loose set screw or lead-header malapposition is extremely rare. We present a patient with complete heart block (CHB) who had PPM malfunction and recurrent syncope, late (14 months) after initial implantation, which was caused by the ventricular lead pin disengagement from the header resulting in oversensing due to noise, pacing inhibition and recurrent syncope. PPM due to lead-header malapposition this late after device implantation has previously not been reported.
Case Presentation A 62 year old man with a past medical history of hypertension and mild coronary artery disease underwent dual chamber permanent pacemaker (PPM) implantation in April of 2015 for complete heart block. A Boston Scientific Ingenio K173 (Boston Scientific, St. Paul, MN) generator was inserted and connected to 2 Medtronic 5076 pacing leads (Medtronic, Minneapolis, MN) which were positioned in the right atrium (RA) and right ventricle (RV). The operative report noted "normal testing results" with an acute RV lead bipolar pacing threshold of 0.6 V at 0.4 msec and pacing impedance of 550 Ω. The PPM was programmed DDDR 60-130 bpm with RA and RV lead outputs programmed 3 times threshold.
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