Dynamic Coronary Artery Compression by Pacemaker Lead

Abstract

A 12 year-old girl with corrected transposition (L-transposition of the great arteries with ventricular inversion) and congenital complete atrioventricular block underwent epicardial pacemaker implantation with a single ventricular lead at 1 week of life. Subsequently, she presented for routine follow-up care in the electrophysiology clinic with no symptomatic concerns. She denied chest pain. Her physical examination was unremarkable, with the pacemaker generator palpable in the left subcostal region. ECG at that time demonstrated ventricular pacing with 100% capture and no evidence of atrioventricular conduction. Her chest x-ray revealed that the pacemaker lead completely encircled the cardiac silhouette and prompted concern for cardiac strangulation (Figure 1). A subsequent computed tomography scan showed a likely restrictive effect on both ventricles caused by the pacemaker lead encircling the heart with concern …