Inadvertent malposition of a permanent pacemaker ventricular lead into the left ventricle which was initially missed and diagnosed two years later: a case report

Medhat F Zaher,Basem N Azab,Marc B Bogin,Soad G Bekheit

doi:10.1186/1752-1947-5-54

Medhat F Zaher, Basem N Azab + Show 2 more

Open Access

https://doi.org/10.1186/1752-1947-5-54

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Abstract

IntroductionInadvertent malposition of a pacemaker ventricular lead into the left ventricle is an uncommon event, and its actual incidence is probably unknown. It may be underestimated and underreported because of a possible asymptomatic course. A 12-lead electrocardiogram is important to confirm proper placement.Case presentationWe report a case of a 60-year-old Caucasian man with a malpositioned transvenous permanent pacing lead into the left ventricle via a patent foramen ovale that was not suspected during implantation and went undiagnosed for two years without complications. The patient remained asymptomatic as he was being treated with oral anticoagulation therapy for atrial fibrillation. The decision was made to leave the pacing lead in place and continue lifelong warfarin therapy.ConclusionsInadvertent insertion of pacing wires into the left ventricle is a potentially dangerous complication that may happen under fluoroscopic guidance and may be overlooked by routine pacemaker interrogation. It is advisable to obtain a 12-lead electrocardiogram during or immediately after transvenous pacemaker implantation rather than use a routine pacemaker interrogation or a limited electrocardiogram.

Highlights

Inadvertent malposition of a pacemaker ventricular lead into the left ventricle is an uncommon event, and its actual incidence is probably unknown
Inadvertent insertion of pacing wires into the left ventricle is a potentially dangerous complication that may happen under fluoroscopic guidance and may be overlooked by routine pacemaker interrogation
left ventricle (LV) pacing after permanent transvenous pacemaker implantation has been reported after ventricular septum or right ventricle (RV) free wall perforation by the lead with subsequent LV pacing [4,5]

Summary

Conclusions

Inadvertent insertion of pacing and internal cardioverter defibrillator wires into the LV is a potentially dangerous complication that may happen even in the most experienced hands. Fluoroscopy during implantation could be difficult and misleading in localizing the site of the ventricular leads. It is advisable that every patient receive a 12-lead ECG in ventricular pace mode during or immediately after implantation. Van Erckelens F, Sigmund M, Lambertz H, Kreis A, Reupcke C, Hanrath P: Asymptomatic left ventricular malposition of a transvenous pacemaker lead through a sinus venosus defect: follow-up over 17 years. Doi:10.1186/1752-1947-5-54 Cite this article as: Zaher et al.: Inadvertent malposition of a permanent pacemaker ventricular lead into the left ventricle which was initially missed and diagnosed two years later: a case report. Competing interests The authors declare that they have no competing interests

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