Rotura de aislante de electrodo de marcapasos por atrapamiento subclavio. Reporte de caso

Miguel Alfonso Meza Aquino; Emilio Pablo Choy Quintanilla

doi:10.47487/apcyccv.v3i2.210

Authors

Miguel Alfonso Meza Aquino Servicio de Cardiología, Hospital María Auxiliadora. Lima, Perú. https://orcid.org/0000-0003-3816-8135
Emilio Pablo Choy Quintanilla Servicio de Cardiología, Clínica Javier Prado. Lima, Perú. https://orcid.org/0000-0002-4924-3762

DOI:

https://doi.org/10.47487/apcyccv.v3i2.210

Keywords:

Pacemaker, Lead failure, Subclavian vein, Axillary vein

Abstract

We present the case of an 82-year-old male patient with a history of single-chamber pacemaker implantation 7 years ago, due to third-degree atrioventricular block, who experienced presyncope. Telemetry showed a warning of possible electrode lead damage and ventricular noise input coinciding with capture failure, so the entire pacing system was programmed to be replaced. During the intervention, breakage of the electrode insulator was observed. The subclavian approach can cause damage to the electrode due to entrapment in the soft tissues it passes through before entering the venous system and iterative stretching. Insulator breakage may manifest as loss of capture and presence of noise on the electrocardiogram, drop in lead impedance, and suggestive radiographic images. The axillary approach is a safe and effective option and is therefore recommended for transvenous lead implantation.

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