A Shocking Complication: Right Ventricular Pacemaker Lead Perforation Presenting With Intractable Hiccups

Right ventricular (RV) lead perforation is a rare but potentially life-threatening complication after pacemaker implantation, with clinical presentations ranging from asymptomatic to severe hemodynamic compromise. Early diagnosis is challenging due to the heterogeneity of symptoms and overlap with other conditions. We present a unique case of a 60-year-old man who presented with intractable hiccups two days after dual-chamber pacemaker implantation. Initial workup was unrevealing; however, persistent symptoms prompted further review of imaging, which revealed RV lead perforation with migration into the left anterior chest wall. The patient underwent successful extraction and repositioning of the lead, resulting in the resolution of symptoms. This case highlights the diagnostic challenge posed by atypical presentations of RV lead perforation, such as persistent hiccups resulting from phrenic nerve or diaphragmatic irritation. Computed tomography is the most sensitive non-invasive diagnostic tool, but a high index of suspicion is essential for timely diagnosis and management. Early intervention is critical to prevent severe complications.