Key result
Inadvertent malposition of a pacemaker ventricular lead into the left ventricle via a patent foramen ovale went undiagnosed for two years without complications, highlighting the importance of a 12-lead ECG during or immediately after implantation.
Case Report (n=1)
A 12-lead ECG in ventricular paced mode is crucial to detect inadvertent left ventricular lead malposition, which can be managed conservatively with lifelong anticoagulation if discovered late.
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May warrant post-implant ECG to detect rare LV lead malposition; leaves open true incidence and optimal screening.
INTRODUCTION: Inadvertent malposition of a pacemaker ventricular lead into the left ventricle is an uncommon event, and its actual incidence is probably unknown. It may be underestimated and underreported because of a possible asymptomatic course. A 12-lead electrocardiogram is important to confirm proper placement. CASE PRESENTATION: We report a case of a 60-year-old Caucasian man with a malpositioned transvenous permanent pacing lead into the left ventricle via a patent foramen ovale that was not suspected during implantation and went undiagnosed for two years without complications. The patient remained asymptomatic as he was being treated with oral anticoagulation therapy for atrial fibrillation. The decision was made to leave the pacing lead in place and continue lifelong warfarin therapy. CONCLUSIONS: Inadvertent insertion of pacing wires into the left ventricle is a potentially dangerous complication that may happen under fluoroscopic guidance and may be overlooked by routine pacemaker interrogation. It is advisable to obtain a 12-lead electrocardiogram during or immediately after transvenous pacemaker implantation rather than use a routine pacemaker interrogation or a limited electrocardiogram.
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Zaher et al. (2011) conducted a case report in Tachycardia-bradycardia syndrome (n=1). Permanent pacemaker implantation with inadvertent left ventricular lead malposition was evaluated on Detection of lead malposition and occurrence of thromboembolic complications. Inadvertent malposition of a pacemaker ventricular lead into the left ventricle via a patent foramen ovale went undiagnosed for two years without complications, highlighting the importance of a 12-lead ECG during or immediately after implantation.
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