Fracture and migration of a pacemaker atrial lead retention wire found by fluoroscopic screening in an asymptomatic patient

We present the case of a woman who had an Accufix atrial ''J'' pacemaker lead implanted in 1990. Subsequently, Telectronics Pacing Systems recalled two models of the atrial leads after problems with fracture and malfunction were reported. One of these models was used in our case. Fifty-two months after implantation, following recommended fluoroscopic screening, our patient was found to have a complete fracture of the ''J'' retention wire with one fragment protruding from the sheath in the right atrium and another fragment of the wire lodged in the right ventricle. The pacemaker had continued to function normally and there was no clinical evidence to suggest such a potentially disastrous fracture. Our report emphasizes the importance of fluoroscopic screening of all patients with atrial leads involved in the recall.