Delayed asymptomatic migration of an implantable cardioverter-defibrillator lead to the costophrenic angle.

摘要

The figure shows a single-chamber defibrilla-tor [implantable cardioverter-defibrillator (ICD)] with a dual-coil, passive-fixation lead (Riata 1570, St Jude Medical, MN, USA) perforating the right ventricular apex with migration of the electrode-tip to the costo-phrenic angle, as suggested by the chest X-ray (Panel A) and confirmed by the computed tomographic (CT) scan (Panels B and C). This event occurred subacutely in a 70-year-old woman implanted in secondary prevention for non-ischaemic dilated cardio-myopathy. It was diagnosed 3 months after ICD implantation (lack of ventricular sensing/capture) without the presence of any symptom or ICD-related finding (recording of false ventricular tachycardia and/or diaphragmatic stimulation). Lead repositioning was performed in the electrophysiology lab (Panel D) without acute/late complications.