Key result
Pacemaker lead malposition in the left ventricle is a rare complication that can present as a transient ischemic attack and may be managed with lifelong anticoagulation if surgery is deferred.
Case Report (n=1)
Pacemaker lead malposition in the left ventricle is a rare complication that can present as a transient ischemic attack and may be managed with lifelong anticoagulation if surgical removal is deferred.
Pacemaker lead malposition in various locations has been described in the literature. Lead malposition in left ventricle is a rare and an underdiagnosed complication. We present a 77-year-old man with history of atrial fibrillation and pacemaker placement who was admitted for transient ischemic attack. He was on aspirin, beta blocker, and warfarin with subtherapeutic international normalized ratio. His paced electrocardiogram showed right bundle-branch block, rather than the typical pattern of left bundle-branch block, suggesting pacemaker lead malposition. Further, his chest X-ray and echocardiogram confirmed the pacemaker lead position in the left ventricle instead of right ventricle. He refused surgical removal of the lead and we increased his warfarin dose. Diagnosis of lead malposition in left ventricle, though easy to identify in echocardiogram, requires high index of clinical suspicion. In asymptomatic patients, surgical removal may be deferred for treatment with lifelong anticoagulation.
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Kalavakunta et al. (2014) conducted a case report in Transient ischemic attack and pacemaker lead malposition (n=1). Pacemaker lead malposition in left ventricle was evaluated. Pacemaker lead malposition in the left ventricle is a rare complication that can present as a transient ischemic attack and may be managed with lifelong anticoagulation if surgery is deferred.
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