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Reprint Address: Joshua E. Glick, Department of Emergency Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
Affiliations
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
A 57-year-old woman with a history of cardiac sarcoidosis, complicated by recent episodes
of nonsustained ventricular tachycardia requiring an implantable cardiac defibrillator,
presented with 2–3 days of substernal chest wall discomfort and palpitations. Her
cardiopulmonary examination was unremarkable, with a regular rhythm and no new murmurs.
Initial electrocardiogram (Figure 1) demonstrated a normal sinus rhythm with no ectopic beats, however, supplemental
electrical pacing spikes (black arrows) were noted to occur at a regular interval
without associated cardiac capture. Chest x-ray study (Figure 2) was notable for a dislodged and retracted single ventricular defibrillator lead
located in the superior vena cava (white star) with proximal coiling of the lead about
the device body (white arrow). The patient denied manipulating the body of the defibrillator,
but did state that she had been frequently adjusting clothing to accommodate her new
device pocket.
Figure 1Electrocardiogram demonstrating a normal sinus rhythm with supplemental regular electrical
pacing spikes without associated cardiac capture.
