Inadvertent left ventricular lead placement causing left bundle branch block paced electrocardiogram: A unique case

Figures

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  Figure 1. A transthoracic echocardiogram (A) and transesophageal echocardiogram (B) showing a device lead coursing through the mitral valve resulting in mild to moderate mitral valve regurgitation.

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  Figure 2. An anteroposterior and lateral chest radiograph showing a very apical device lead course with a higher than expected right-to-left crossing point (anteroposterior film) and a posteriorly directed device lead (arrow, lateral film).

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  Figure 3. A cardiac computed tomographic film (A) demonstrating a malpositioned device lead crossing through a sinus venosus atrial septal defect and inserting into the septal aspect of the left ventricle. Bicaval transesophageal echocardiographic view showing the device lead crossing from the right atrium to the left atrium through a sinus venosus atrial septal defect (B).

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  Figure 4. A ventricular paced electrocardiographic strip through the malpositioned device lead within the left ventricle demonstrating a left bundle branch block QRS morphology with a superior frontal axis between −90° and −120°.

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  Figure 5. Explanted implantable defibrillator device generator and lead without any obvious adherent thrombi.

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  Supplementary Figure 1. ECG: 12-lead ECG obtained prior to pacemaker implantation. Rhythm is atrial fibrillation with incomplete RBBB morphology and non-specific T-wave flattening.