A Rare Case of Extreme Form of Subclavian Crush Syndrome

Figure 1.

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A 60-year-old gentleman with history of implantation of dual-chamber pacemaker 1 year back for complete heart block presented to our hospital for routine pulse generation interrogation. Electrocardiogram showed atrioventricular dissociation with ventricular pacing at 60 beats per min. Pacemaker interrogation revealed low impedance of atrial lead and no capture of atrium even at highest output of 7 V. Ventricular lead parameters were within normal limit. Fluoroscopy revealed complete transection of proximal atrial lead with floating distal atrial lead in right atrium (Figure 1). Subclavian crush syndrome is rare but known complication of cardiac implantable electronic devices and occurs due to entrapment of the lead between first rib and clavicle. It occurs more in subclavian vein approach and rarely in extra thoracic axillary vein and cephalic vein cut down approach for lead insertion. Our case is a rare and extreme form of subclavian crush syndrome, which occurred within a short period of time (1 year after implantation).