When Stability Fails: Rare Very Late Dislodgement of 3830 Lead

TL;DR

A rare case of a pacemaker lead dislodging three years after implantation is reported, highlighting the need for long-term monitoring.

Contribution

This case report highlights the rare occurrence of very late dislodgement of a lumenless lead used for cardiac pacing.

Findings

A Medtronic SelectSecure 3830 lead dislodged three years after implantation, causing capture failure.

The lead coiled in the pacemaker pocket and was successfully extracted and replaced.

Late lead dislodgement can occur with lumenless leads, requiring continued vigilance.

Abstract

We report a rare case of very late dislodgement of a Medtronic SelectSecure 3830 lumenless lead three years after successful left bundle branch area pacing. An 88‐year‐old patient with permanent atrial fibrillation and bifascicular block underwent VVIR pacemaker implantation in 2022 with excellent initial parameters (threshold 0.8 V at 0.5 ms, impedance 650 Ω) and stable follow‐up for three years. The patient presented with pre‐syncopal episodes, and device interrogation revealed capture failure with elevated threshold (2.25 V/0.4 ms) and decreased impedance. Fluoroscopic comparison confirmed macro‐dislodgement of the lead with coiling in the pacemaker pocket. The SelectSecure lead was successfully extracted and replaced with a conventional stylet‐driven lead positioned in the right ventricular mid‐septum. This case highlights that late lead dislodgement can occur with lumenless leads even years after successful implantation, emphasizing the need for continued vigilance during long‐term follow‐up of cardiac physiological pacing systems.

There is a growing interest for cardiac physiological pacing in recent times. Despite its favorable safety profile, very late lead dislodgement may occur with the Medtronic SelectSecure 3830 lumenless lead even years after implantation. We should be extremely vigilant to identify this rare complication so that restorative measures can be taken instantaneously.

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