A Rare Case of Complete Fragmentation of Pacemaker Lead after a High-Velocity Theme Park Ride

Abstract

Pacemaker lead fracture is one of the most common causes of pacemaker malfunction and is most frequently associated with weight lifting or chest trauma. These patients usually present with symptoms of dizziness, syncope, chest discomfort, and palpitations or less commonly with extracardiac symptoms. Diagnosis is made by ECG and careful review of chest imaging such as chest X-ray or fluoroscopy. Treatment involves placement of a new lead with or without extraction of the fractured lead. We present an interesting case of complete severance of the tip of a dual-chamber pacemaker's atrial lead after a high-velocity theme park ride. In our case, the fracture occurred during amusement park rides and went undiagnosed until the patient presented for routine pacemaker evaluation. This case indicates that extreme physical forces in the absence of direct trauma, such as during amusement park rides, may result in lead fractures and patients with pacemakers should be cautioned regarding such activities.

Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report

“…Pacemakers play an important role in the treatment and management of patients with bradyarrhythmias. Yet, complications after implantation can lead to significantly worse outcomes [ 5 ]. Leads are considered the most vulnerable part of the pacemaker device.…”

“…Leads are considered the most vulnerable part of the pacemaker device. The reported incidence rate of lead fracture ranges from 0.1 to 4.2% per year [ 1 , 5 ].…”

“…Crush injury, also known as subclavian crush syndrome, is a delayed complication of pacemaker implantation that can also cause lead fracture [ 6 , 7 ]. Lead fractures caused by it [ 5 ] are more frequently seen and reported than those caused by trauma or injury [ 2 , 3 , 4 ]. However, it was not considered the reason for lead fracture in this case.…”

Automated Implantable Cardioverter Defibrillator/Pacemaker Lead Fracture

“…This decision depends on specific factors related to the patient and their ICD, such as the age of the patient, the age and functionality of the fractured lead, the number of leads in the ICD [ 6 ]. In many cases, the fractured lead is capped and left inside of the patient in an effort to prevent potential lead extraction complications such as cardiac perforation and arrhythmias [ 5 ]. However, the complications of leaving a fractured lead inside of a patient (such as vein blockage and interference with working leads) must also be taken into account.…”

“…Patients experiencing loss of consciousness, chest pain or discomfort, dizziness and palpitations should immediately consult their physician in case of lead fracture. The diagnosis is then made by careful review of chest radiography and ECG results [ 5 ]. Lead fracture is a particularly urgent issue for patients who heavily depend on their pacemakers for normal cardiac function.…”