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Potentially fatal atrial pacemaker lead disruption detected by fluoroscopic surveillance

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In March 1994, a 66 year old man underwent atrial pacemaker implantation using an Accufix 330-801 lead (Telectronics) for sinus arrest. After the manufacturer's recall, the atrial lead was checked by fluoroscopy every six months as recommended. In April 1999, five years after implant, protrusion of the J-shaped retention wire through the leadinsulation into the right atrium was detected (left). This complication is associated with a significant risk of cardiac perforation, tamponade, and sudden death. The lead and the J retention wire were therefore extracted transvenously with some unraveling of the conductor, but without complication (above). A replacement pacing system was implanted. Potentially life threatening disruption of an Accufix lead late after implant may initially be asymptomatic and not associated with pacemaker malfunction. Surveillance fluoroscopy may be life saving.