case_images: PMC6220749_01
case_images: 12-lead ECG showed normal sinus rhythm with loss of capture of atrial lead.
case_images: CRIC2018-4192964.001.jpg
case_images: PMC6220749_01_CRIC2018-4192964.001.jpg
case_images: fig1
case_images: A 12-lead ECG showed normal sinus rhythm with a heart rate of 60 beats per minute and atrial pacing spikes with loss of capture (Figure 1).
case_images: Device evaluation showed loss of atrial capture and sudden increase in lead impedance from normal in May 2017 (yellow circle) to 2000 ohms in August 2017 (blue circle).
case_images: CRIC2018-4192964.002.jpg
case_images: PMC6220749_01_CRIC2018-4192964.002.jpg
case_images: fig2
case_images: Lead impedance history clearly showed an abrupt increase in the atrial lead impedance in August, at the time patient had visited the theme park, from around 600 ohms to 1000 ohms and subsequently above 2000 ohms (Figure 2).
case_images: PA chest X-ray showed fractured right atrial lead (blue arrow).
case_images: CRIC2018-4192964.003.jpg
case_images: PMC6220749_01_CRIC2018-4192964.003.jpg
case_images: fig3
case_images: A chest X-ray (CXR) was obtained which revealed an intact right ventricular lead and complete severance of the right atrial lead tip (Figures 3 and 4).
case_images: Lateral chest X-ray showed right atrial lead fracture (blue arrow).
case_images: CRIC2018-4192964.004.jpg
case_images: PMC6220749_01_CRIC2018-4192964.004.jpg
case_images: fig4
case_images: A chest X-ray (CXR) was obtained which revealed an intact right ventricular lead and complete severance of the right atrial lead tip (Figures 3 and 4).