Left Phrenic Nerve Stimulation Due to Breakage of the Endocardial Right Ventricular Lead at the Costoclavicular Ligament

Abstract

A 78-year-old man with a permanent pacemaker (PM) implanted in his left prepectoral area reported twitches in his left lateral abdominal region. Chest X-rays revealed a broken right atrial (RA) lead and a fracture of the right ventricular (RV) lead at the left costoclavicular ligament. The electrocardiogram (ECG) and the Holler ECG revealed atrial fibrillation (AF) and an improperly functioning PM. We observed that the twitching seemed to correspond with each pacing beat and that it did not appear with his own beat. We suspected that the twitching was due to electric current leakage from the broken RV lead. We performed a PM re-implantation with a screw-in RV lead using the extrathoracic approach. After re-implantation the twitching disappeared. Costoclavicular ligament related electrode lead fractures are not uncommon and electric current leaks can be a source of problems in cardiac pacing. In this case, the electric current leak from the broken RV lead at the costoclavicular ligament stimulated the left phrenic nerve.

Keywords

• Electric current leak
• Extrathoracic approach
• Twitching
• Lead fracture
• Subclavian crush syndrome