Cardiac strangulation with chronic ab-extrinseco occlusion of the left-circumflex artery from an epicardial lead: a case report

The diagnosis of CS in patients with epicardial PM leads remains challenging, especially in adults with atypical clinical presentation; thus, any clinical or instrumental clue should prompt further higher-level imaging investigations, such as CCTA or ICA. It is also important to disclose that sometimes CS can be only a collateral finding with no relationship with the patient's symptoms.