Dual Chamber Pacemaker Implantation Complicated by Left Anterior Descending Coronary Artery Injury

Figures

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  Figure 1. Device Interrogation (A) Device interrogation demonstrating A-sensed, V-paced rhythm with initiation of spontaneous ventricular fibrillation, which required external 200-J defibrillation. (B) Twelve-lead ECG demonstrates sinus rhythm with a right bundle branch block and ST-segment elevations in leads V2 to V6, II, III, and aVF. ECG = electrocardiography.

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  Figure 2. Cranial Angiographic Images (A) LAO cranial angiographic image demonstrates severe vasospasm of the mid-to-distal LAD, with the RV lead clearly seen to the right of the interventricular septum but with insertion near the distal LAD. (B) RAO cranial angiographic image after intracoronary nitroglycerin administration demonstrates improvement in LAD vasospasm but obstruction of flow at the RV lead insertion site. (C) RAO view with Choice Floppy intracoronary wire, with restoration of flow to the distal LAD. The RV lead can be seen with insertion obstructing the LAD. (D) Angiographic image obtained immediately after pull-back of the RV lead, with a small area of contrast extravasation at the original RV lead insertion site (red circle). (E) Repeated angiographic image <2 min after RV lead pull-back demonstrates resolution of contrast extravasation from the LAD. (F) Final RV lead position with no evidence of contrast extravasation. See Videos 1, 2, and 3. LAD = left anterior descending; LAO = left anterior oblique; RAO = right anterior oblique; RV = right ventricular.