Incomplete pacemaker lead fracture revealed by superficial maneuvers

A 75-year-old man presented to our department with a complaint of recurrent syncope episodes seven years after dual chamber pacemaker implantation due to complete atrioventricular block. His electrocardiogram obtained on presentation showed a normal dual-chamber pacemaker rhythm. The chest X-ray and pacemaker interrogation did not show any lead fracture or dysfunction. Twenty-four hour Holter monitoring revealed periods of failure to pacing. Superficial maneuvers over the skin resulted in an excessive increase in the ventricular lead impedance and pacing failure. The clinical course of the patient was uneventful after implantation of a new electrode to the right ventricular apex.