Bleeding from the heart: Chronic anemia from a pacemaker lead–related ventriculopleural fistula

Chronic anemia can be the result of nutritional deficiency, chronic illness, or blood loss, typically identified through standard laboratory and imaging workup. Cardiac implantable electronic device (CIED) lead perforation is a well-known implant complication, often initially diagnosed by identifying elevated capture thresholds and poor sensing – usually shortly after implant. However, in rare cases, perforation may occur or progress insidiously, evading early detection. With the increasing prevalence of same-day discharges after CIED procedures, and reliance on CIED remote monitoring transmission, device programming for diagnostic sensitivity is critical – and may differ than typical programming used when in-person device checks may be more frequent.