Key Points
- Document the long-term clinical course and diagnostic findings of an asymptomatic transvenous pacemaker lead inadvertently implanted into the left ventricle through an unsuspected sinus venosus defect.
- Evaluated a female patient presenting with suspected pacemaker catheter malposition using chest radiography and electrocardiography.
- Employed two-dimensional transthoracic and transesophageal echocardiography to visualize the anatomical course of the lead through the interatrial septum and mitral valve.
- Monitored clinical history over a 17-year follow-up period and managed the malpositioned lead conservatively with warfarin sodium anticoagulation instead of surgical removal.
- Transesophageal echocardiography confirmed that the pacemaker lead crossed directly through an unrecognized sinus venosus defect into the left atrium and through the mitral valve to the left ventricular endocardium.
- No attached thrombotic material, neurological deficits, or peripheral embolic events occurred over more than 17 years of follow-up.
Structured PICO
PPopulation1 woman with an asymptomatic transvenous left ventricular endocardial pacemaker lead malpositioned through a sinus venosus defect
IInterventionObservation (no operative correction) and initiation of warfarin sodium therapy
OOutcomeClinical course (neurological deficiencies or peripheral embolic phenomena)hard clinical
This case demonstrates that a malpositioned left ventricular pacemaker lead through a sinus venosus defect can remain asymptomatic without embolic events for over 17 years.