Complete Transection of Permanent Pacemaker Lead by a Dislocated Left Shoulder Prosthesis

A case of complete transection of the leads of a permanent pacemaker (PPM) by a dislocated left shoulder prosthesis is reported. An 86 year old woman with a history of B-cell lymphoma diagnosed subsequent to a pathological fracture of the humerus in 2010 was managed by a left shoulder replacement. Subsequently, she underwent chemotherapy for the B-cell lymphoma and the malignant lesion was reported to have resolved. In addition, she further went on to have a PPM- left sided DDDR inserted in 2015 for chronotropic incompetence. Following a mechanical fall she had in 2021, it was found that the PPM leads had been damaged, transected, potentially infected and failing to capture along with a displaced left shoulder prosthesis which was the likely culprit for the PPM damage. A decision was made to not remove the dislocated prosthesis by the multidisciplinary team managing her. This case highlights the importance of an understanding of the complications of shoulder surgeries, including approach adopted for surgery in patients with pacemaker in-situ and the need for regular follow up and imaging.