When Stability Fails: Rare Very Late Dislodgement of 3830 Lead

We report a rare case of very late dislodgement of a Medtronic SelectSecure 3830 lumenless lead three years after successful left bundle branch area pacing. An 88-year-old patient with permanent atrial fibrillation and bifascicular block underwent VVIR pacemaker implantation in 2022 with excellent initial parameters (threshold 0.8 V at 0.5 ms, impedance 650 Ω) and stable follow-up for three years. The patient presented with pre-syncopal episodes, and device interrogation revealed capture failure with elevated threshold (2.25 V/0.4 ms) and decreased impedance. Fluoroscopic comparison confirmed macro-dislodgement of the lead with coiling in the pacemaker pocket. The SelectSecure lead was successfully extracted and replaced with a conventional stylet-driven lead positioned in the right ventricular mid-septum. This case highlights that late lead dislodgement can occur with lumenless leads even years after successful implantation, emphasizing the need for continued vigilance during long-term follow-up of cardiac physiological pacing systems.