A severed pacemaker lead entrapped in a hepatic vein.

Complete lead fracture is a uncommon phenomenon in cardiac pacing. Recently we encountered a patient with a severed lead at routine pacemaker follow-up visit. In this case report, the typical ECG changes and noninvasive pacemaker measurements are discussed. The chest roentgengram showed the position of the proximal part of the lead, but this technique could not establish the exact position of the distal part of the lead. Ultrasound recording of the upper abdomen demonstrated that the distal part of lead was entrapped in the great hepatic vein. Since this position was stable with one end in the right ventricular apex and the other end in a hepatic vein, no further action was undertaken to remove this part of lead. The proximal part of the lead and the pulse generator were explanted. So far the clinical course of the patient has been uneventful. Strategies to remove severed leads are discussed based on a review of the literature.