title: Medial subclavicular musculotendinous complex and insulation break: Rare cause of late pacemaker lead malfunction.
abstract: Insulation break in a permanent pacemaker lead is a rare long-term complication. We describe an elderly male with a VVIR pacemaker, who presented with an episode of presyncope more than 3 years after the initial implantation procedure, attributed to insulation break possibly caused by lead entrapment in components of the medial subclavicular musculotendinous complex (MSMC) and repeated compressive damage over time during ipsilateral arm movement requiring lead replacement. The differential diagnosis of a clinical presentation when pacing stimuli are present with failure to capture and the role of the MSMC in causing lead damage late after implantation are discussed.
authors.affiliation: Associate Professor of Cardiology, Gauhati Medical College, Guwahati, Assam, India. Electronic address: drpranabguwahati@gmail.com.
authors.forename: Pranab Jyoti
authors.initials: PJ
authors.lastname: Bhattacharyya
authors.affiliation: DM Resident, Department of Cardiology, Gauhati Medical College, Assam, India.
authors.forename: Shweta
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Professor of Cardiology, Department of Cardiology, Gauhati Medical College, Assam, India.
authors.forename: Jogesh Chandra
authors.initials: JC
authors.lastname: Barkataky
authors.affiliation: Professor and Head, Department of Cardiology, Gauhati Medical College, Assam, India.
authors.forename: Anjan Kumar
authors.initials: AK
authors.lastname: Bhattacharyya
mesh_terms: D000368:Aged; D020878:Device Removal; D004562:Electrocardiography; D004868:Equipment Failure; D006327:Heart Block / Q000628:therapy*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*
keywords: Insulation break; Late complication; Medial subclavicular musculotendinous complex (MSMC); Pacemaker lead