Six uneventful years with a pacing lead in the left ventricle

Abstract

A 61-year-old asymptomatic man was referred to our institution for surgical repair of an aortic root aneurysm. His medical history was significant for mechanical aortic valve replacement 9 years ago, subsequent long-term anticoagulation, and dual-chamber pacemaker implantation for heart block 6 years ago. A preoperative electrocardiogram (Figure 1A) showed a right bundle branch block pattern of paced beats that raised the suspicion of lead malposition in the left ventricle (LV). Lateral (Figure 1B) and posteroanterior (Figure 1C) chest radiography further suggested the diagnosis. On the lateral chest radiography, the ventricular lead (arrow) appeared to