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Damage to Damage to Pacemaker Lead during MammographyLead during Mammography
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     To the Editor: A 73-year-old woman presented on March 22, 2005, for routine evaluation of her VVIR (ventricular pacing, ventricular sensing, inhibition response, rate-adaptive) cardiac pacemaker. The unit had been implanted in the right pectoral region in 1980 because of the sick sinus syndrome. Her current pacemaker lead was the original Cordis lead. On examination, she was alert; she was 1.55 m in height and weighed 40.8 kg. She said that she had no syncope, presyncope, or pectoral wound stimulation.

    Investigation of the pulse generator showed that a lead warning had occurred on December 21, 2004, and demonstrated the right ventricular lead impedance to be 3874 ohms (a dramatic increase from 609 ohms on June 10, 2003, and 638 ohms at implantation). A rhythm strip showed frequent failure to sense and total failure to capture by the pacemaker; the patient's native sinus rhythm was normal at a rate of 60 beats per minute. A chest radiograph showed a 1-mm break in the conducting element of the pacemaker lead in the pectoral area. She underwent placement of a new lead and a new pulse generator.

    When I saw her in my office five days later, she recalled that she had had screening mammography on December 21, 2004 (the same date that the lead warning had occurred). She recalled that, when her right breast was firmly compressed between the radiography plate and the upper plate, the pain was so excruciating that she screamed, and the procedure was aborted until the pain resolved. Bilateral mammography was then carried out uneventfully. Given the coincident timing of this patient's mammogram and the lead fracture, it is likely that the lead was crushed during the initial attempted mammography. Mammography and pacemaker implantation are both common procedures. More than 30 million women in the United States have mammograms annually; there are also 3 million American women with cardiac pacemakers.1

    In conclusion, damage to a permanent pacing lead occurred during mammography. During mammographic examination in women with cardiac pacemakers, strict attention must be paid to avoiding damage to the pacemaker.

    Mark M. Sherman, M.D.

    Cardio-Thoracic and Vascular Surgery

    Springfield, MA 01107

    References

    Joseph K-A. The crisis in mammography. Vol. 3. No. 12. InVivo. New York: Columbia University Medical Center, November/December 2004:1-3.