Subcutaneous Implantable Cardioverter-Defibrillator Lead Dislodgement Masquerading as Left Shoulder Pain

Abstract

Implantable cardioverter-defibrillators (ICDs) have demonstrated efficacy in the prevention of sudden cardiac death secondary to cardiac arrhythmias in eligible patients. Complications with the subcutaneous ICD (S-ICD) are rarer than with the transvenous ICD but do still exist. Our patient presented four weeks after the insertion of S-ICD with complaints of left shoulder pain radiating to the chest wall and swelling over the S-ICD site. He was initially treated for rotator cuff injury and subacromial impingement syndrome but upon obtaining chest radiography was found to have a lead displacement traversing the splenic flexure of the colon. The patient was managed by a treatment team involving cardiology, surgery, and infectious disease and underwent S-ICD removal, exploratory laparotomy with splenic flexure mobilization, and completion of a four-week antibiotic course ultimately leading to reimplantation of S-ICD.