Medical mystery--the answer.

Abstract

To the Editor: The medical mystery in the June 13 issue1 involved a 76-year-old man with sinus node disease who was evaluated after an episode of syncope and who received a single-chamber pacemaker through the left subclavian approach. The medial pathway of the pacing lead on the chest film (Figure 1), coupled with the finding of right bundle-branch block on the paced electrocardiogram (Figure 2), confirms that the lead had been passed by means of the subclavian artery through the ascending aorta, across the aortic valve, and into the left ventricle. A new, dual-chamber pacemaker was placed through the right . . .