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Intramyocardial Migration of a Defibrillator Lead

A 72-year-old male was evaluated for high thresholds in an implantable cardioverter defibrillator (ICD) (Medtronic Sprint Quattro Secure Model #6947; Medtronic, Inc., Minneapolis, MN, USA) initially inserted in 2005. Coronary angiography revealed three vessel disease and an echocardiogram showed an ejection fraction of 35%, severe mitral regurgitation, and moderate tricuspid regurgitation. The pigtail of the ICD lead appeared to lie over the left anterior descending artery (LAD) (Fig. 1). At the time of surgery, the leadwas noted to be outside the heart adjacent to the LAD (Fig. 2). It had migrated through the body of the anterior papillary muscle of the tricuspid valve and across the anterior wall of the right ventricle. The lead was dissected free and the distal 10mm was transected. The defect was repaired with an 8-0 prolene suture (Fig. 3). The patient underwent coronary revascularization, mitral and tricuspid valve repair, and epicardial implantation of an atrio-biventricular pacing system.He tolerated the procedurewell and had an uncomplicated postoperative course.