# Defibrillator Lead Perforation Leading to Concerning Electrocardiogram Findings: Case Report

## TL;DR

A case report describes a patient with an implantable cardioverter-defibrillator experiencing chest pain and ECG changes due to lead perforation.

## Contribution

Highlights ICD lead perforation as a rare but important cause of chest pain and ECG changes in patients with ICDs.

## Key findings

- ST-segment elevation on ECG was observed in a patient with ICD lead perforation.
- Computed tomography confirmed lead migration in the case.
- The patient was successfully treated with lead revision and discharged.

## Abstract

Implantable cardioverter-defibrillator (ICD) lead perforation through the myocardium may result in chest pain and electrocardiogram (ECG) changes concerning for ST-segment elevation myocardial infarction. The clinical context of the ECG aids in appropriate management.

We report the case of a 71-year-old woman experiencing chest pain after an ICD placement two weeks earlier. On presentation, she exhibited ST-segment elevation on her ECG. Computed tomography confirmed ICD lead migration. The patient’s hemodynamics were normal, and she was discharged home after a five-day hospital stay following a lead revision.

Although rare, ICD lead perforation is a potential cause of chest pain and ischemic ECG changes. Emergency physicians should consider lead perforation as a potential differential diagnosis when evaluating chest pain in patients with ICDs, taking into account the potential complications of coronary angiography.