Asymptomatic Anterior Perforation of an ICD Lead into Subcutaneous Tissues

A 71‐year‐old woman underwent routine impantable cardioverter defibrillator implantation. On a predischarge check the next day, electrical signals and thresholds were excellent and similar to those at implant. The chest X‐ray was unremarkable and showed good lead position at the right ventricular apex (RVA). At a routine one‐month postimplant visit, electrograms were found to be miniscule, and pacing could not be achieved. Chest X‐ray and fluoroscopy suggested perforation, then this was confirmed by computed tomography scan. The tip of the lead was estimated to be within 7 mm of the surface of the skin. The system was removed surgically, and the patient continued to do well.