Dislodgement of atrial lead of the CRT-D system and its migration into the pocket presenting as its absence on chest x-ray.

Lead dislodgement and migration is a known complication after implantation of cardiac rhythm devices. We present a case of dislodgement of atrial lead of the CRT-D system and its migration into the device pocket. The device itself had rotated by 90 degrees but the right and left ventricular leads were not at all affected. The case is unique because the lead had coiled up and was lying behind the device in the pocket and hence was not even seen on a chest x-ray.