Medical Journal of Mashhad university of Medical Sciences

Medical Journal of Mashhad university of Medical Sciences

Successful Lead Abandonment as a Safe Strategy in Complex Pacemaker Lead Entrapment: A Case Report and Review of the Literature

Document Type : Case report

Authors
alireza heidari-bakavoli 1
gholamhosein kazemzadeh 2
muhammad dashti khavidaki 3
1 Cardiology department, Mashhad university of medical science, mashhad, iran
2 Vascular & Endovascular Surgery Research Center, Mashhad university of medical sciences, mashhad, iran
3 Cardiology department, mashhad university of medical sciences, mashhad, iran
10.22038/mjms.2026.94849.5246
Abstract
Introduction: Managing dysfunctional pacemaker leads in elderly patients requires careful consideration of the risks associated with extraction versus the potential long-term complications of abandonment.



Case Presentation: An 87-year-old female with a dual-chamber pacemaker implanted two years prior for complete heart block presented with syncopal episodes following heavy lifting. Device interrogation showed intermittent high impedance and elevated threshold in the right ventricular (RV) lead with intermittent capture failure induced by pocket manipulation. Chest radiography revealed no macroscopic lead defect. Extraction of the RV lead using simple traction resulted in dislodgement of the right atrial (RA) lead. Attempts to reposition failed, and subsequent efforts to extract both leads led to their entanglement within the left subclavian vein. Further endovascular extraction attempts were unsuccessful. After discussing surgical risks versus conservative options with the patient and family, the decision was made to abandon the leads. The proximal portions were cut and sutured to the pocket floor, and a new pacemaker system was implanted via the right subclavian vein. At one-year follow-up, the new device functioned normally, and the left subclavian vein remained patent on Doppler ultrasound.



Conclusion: In elderly patients with complex lead entrapment where extraction carries high procedural risk, lead abandonment with careful clinical surveillance offers a safe and effective alternative to invasive removal.
Keywords
Abandoned Pacemaker Leads
Lead Fracture
Lead Extraction Complication
Subclavian Vein Entrapment
Case Report
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Medical Journal of Mashhad university of Medical Sciences
Volume 69, Issue 6
June 2026
Pages 646-651