Early Right Ventricular Implantable Cardioverter-Defibrillator Lead Microdislodgement Associated With Active-Fixation Helix Retraction: A Case Report

Lead dislodgement is an important early complication of cardiac implantable electronic device (CIED) implantation, and microdislodgement may be clinically significant despite little or no visible change in lead position on standard radiography.We report the case of an 87-year-old man with ischemic dilated cardiomyopathy, previous transcatheter aortic valve implantation (TAVI), and a pre-existing right-sided pacemaker for high-degree atrioventricular block.A dual-chamber implantable cardioverter-defibrillator (ICD) was implanted for secondary prevention after syncope associated with ventricular tachycardia.The newly implanted right ventricular (RV) defibrillator lead had satisfactory acute electrical parameters.Within the following days, the patient developed recurrent symptoms, slow ventricular tachycardia, and dynamic RV lead dysfunction evident during upper-limb mobilization.Device interrogation before lead revision showed an elevated RV pacing threshold, reduced R-wave amplitude to 2-3 mV, and an increase in lead impedance to 1500 Ω. Retraction of the active-fixation screw was identified.A few days after implantation, a new RV defibrillator lead was positioned at the RV apex, after which the dysfunctional lead was removed.Subsequent device follow-up was reassuring, with no recurrent RV lead dysfunction documented at long-term follow-up.This case highlights the diagnostic challenge of early ICD lead microdislodgement and the value of integrating symptoms, device interrogation, telemetry, imaging, and dynamic mechanical assessment.