Key result
A malpositioned pacemaker lead in the left ventricle was diagnosed using chest X-ray and transesophageal echocardiography in a 71-year-old woman presenting with transient ischemic attacks.
Case Report (n=1)
No
This case highlights the importance of investigating a new RBBB pattern after right ventricular pacing and utilizing chest X-ray or transesophageal echocardiography when transthoracic echo is inadequate to rule out lead malposition.
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May prompt CXR/TEE for LV lead malposition in new RBBB with TIA; single case report leaves open prospective diagnostic algorithms.
Transvenous right ventricular pacing usually shows a left bundle branch block (LBBB) pattern. When right bundle branch block (RBBB) pattern appears after the insertion of an electrode, perforation or malposition of the pacing lead usually occurs. However, when the pacing lead that is inserted into the coronary sinus or right ventricle extends to right ventricle septum, RBBB pattern may appear. Echocardiography, due to inadequate echo images or reflections, may result in early clinical misdiagnosis since it cannot be evaluated well. Another reason for the errors in diagnosis is that cardiologists generally relegate telegraphy evaluations to a second plan. Here, we present a case of pacemaker malposition, which was diagnosed using X-ray radiography after multiple failed evaluations with echocardiography.
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Alan et al. (2015) conducted a case report in Pacemaker malposition (n=1). Transvenous VDD pacemaker implantation was evaluated on Diagnosis of pacemaker malposition. A malpositioned pacemaker lead in the left ventricle was diagnosed using chest X-ray and transesophageal echocardiography in a 71-year-old woman presenting with transient ischemic attacks.
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