Delayed Cardiac Perforation Caused by Pacemaker Lead Dislodgement During Chiropractic Therapy.

BACKGROUND

Cardiac perforation caused by pacemaker lead dislodgement is a rare but potentially fatal complication. Although early dislodgement is a common cause in such cases, external mechanical forces can also cause delayed perforation.

CASE SUMMARY: An 83-year-old man with a pacemaker presented with dyspnea and syncope. Chest radiography showed right ventricular lead migration with perforation, and echocardiography confirmed hemopericardium. Lead dislodgement was suspected to be caused by prior chiropractic therapy for shoulder rehabilitation. The dislodged lead was extracted, and a new lead was repositioned in the interventricular septum for left bundle branch pacing.

DISCUSSION: This case highlights the risk of delayed cardiac perforation attributable to mechanical stress caused by rehabilitation and underscores the need for patient education and cautious placement strategies to minimize complications.

TAKE-HOME MESSAGES: Patients with pacemakers should be counseled regarding the risks of physical activity. Multimodal imaging aids in early detection of lead-related complications.