Pacemaker Lead Failure due to Subclavian Crush Syndrome: A Case Report

Background: Lead insulation failure or lead fracture due to crush injury is one of the potential complications of cardiac implantable electronic device (CIED) implantation. It usually occurs after medial intrathoracic puncture of the subclavian vein and results in damaging of the lead body by entrapment within the costoclavicular ligament and/or the subclavian muscle.We are presenting a case of a pacemaker lead failure due to subclavian crush syndrome that occurred twice, and it led to the acquisition of new pacing lead entry site. Case: A 50-year-old male patient with a history of symptomatic bradycardia due to sick sinus syndrome. He was a manual worker and right-handed. He underwent dual chamber pacemaker implantation initially in the left pectoral area, but it was removed a year later due to infection complicating traumatic hematoma to the pacemaker pocket. He underwent implantation of a new pacemaker system on the right side with leads insertion through a percutaneous right subclavian vein puncture (SVP). He developed right atrial (RA) lead failure about 11 years later due to subclavian crush syndrome. He underwent a new RA lead implantation from the same site. He again had an RA lead malfunction about two years later due to the same mechanism. He eventually underwent a new pacemaker system implantation via the right cephalic vein. Discussion: The cardiac pacing leads are prone to dislodgement, insulation failure, and conductor fracture. Lead fractures are seen with an incidence rate of 0.1 to 4.2% per patientyear. The cephalic vein cut down (CVC) and axillary vein puncture (AVP) approaches show better long-term efficacy and lower lead complication rates than the SVP approach for permanent pacemaker implantation. Conclusion: Subclavian crush syndrome is one of the recognized causes of CIEDs lead failure, and it occurs mostly with SVP. Alternative approaches such as CVC down and AVP have been associated with better outcomes and fewer incidences of subclavian crush syndrome in comparison with the SVP approach.International Journal of Clinical and Medical Cases (ISSN:2517-7346