Abstract
A 73-year-old man had a DDD pacemaker implanted in 1991 for symptomatic high-degree atrioventricular block. Because of atrial lead dysfunction, a new atrial lead was implanted in 1998. Ten years later, the patient experienced unexplained ascites and edema with progressive exertional dyspnea, for which he was referred. Chest radiography showed a loop of the ventricular lead at the level of the tricuspid valve (Figure 1). Transthoracic echocardiography demonstrated an enlarged right atrium. The mean diastolic gradient across the tricuspid valve was 15 mm Hg with a peak pressure drop of 29 mm Hg without tricuspid regurgitation (Figure 2). No other abnormalities were found. Transesophageal echocardiogram revealed looping of one of atrial leads at the …
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