A Case of Atrial Lead Dislodgement after Surgery for Lung Cancer

Case is a 77 years-old female. She started having episodes of palpitations followed by pre-syncope from 3 months ago. Holter ECG was performed which revealed runs of paroxysmal atrial fibrillation followed by sinus pause up to 4.3 seconds, which was consistent with the symptoms. With the diagnosis of bradycardia-tachycardia syndrome, DDD pacemaker implantation was performed. Tined leads were implanted to right atrial appendage and right ventricular apex without any complications. Shortly after the pacemaker implantation, patient was found to have left lung cancer. Left upper lobe resection and broad partial left lower lobe resection was performed 3 months after the pacemaker implantation. Two days after the surgery, monitor ECG revealed atrial lead sensing and pacing failure, and atrial lead dislodgement was observed on chest rentogenography. The left lung resection caused the mediastinum to shift leftward, resulting in advancement of the leads which lead to the dislodgement. Atrial lead repositioning was performed which only needed a short pull of the lead. We report a case of atrial lead dislodgement after surgery for lung cancer due to the shift of the mediastinum.