Case report: An unusual case of phrenic nerve stimulation in a patient with single chamber implantable cardioverter defibrillator

Figures

• 

  FIGURE 1. (A) 12-lead ECG at admission showing AF with rapid ventricular response despite rate-control therapy. (B) 12-lead ECG showing phases of AF with slow ventricular response with ventricular pacing at the lower rate (ICD in VVI 30). Note the morphology of the paced QRS with RBBB pattern, superior axis with R pattern in aVR. AF, atrial fibrillation; ICD, implantable cardioverter defibrillator; RBBB, right bundle branch block.

• 

  FIGURE 2. PA (A) and LL (B) chest x-ray of the patient showing inadvertent lead placement in the posterior branch of the coronary sinus. PA, posteroanterior; LL, laterolateral.

• 

  FIGURE 3. (Superior row) PA (A), RAO 30° (B), and LAO 45° (C) fluoroscopic views of the previously implanted single chamber cardioverter defibrillator with a single coil passive fixation defibrillation lead. (Inferior row) PA (D), RAO 30° (E), and LAO 45° (F) fluoroscopic views after lead extraction and the reimplantation of a new single-coil active fixation defibrillation lead on the mid portion of the interventricular septum and a coronary sinus quadripolar passive fixation lead for cardiac resynchronization therapy. PA, posteroanterior; RAO, right anterior oblique; LAO, left anterior oblique.

• 

  FIGURE 4. LAO 45° fluoroscopic views of the previously implanted single chamber cardioverter defibrillator (A) and the subsequently implanted biventricular cardioverter defibrillator (B). Note that in A the defibrillation lead crosses the midline toward the left ventricle. LAO: left anterior oblique; RV, right ventricle; IVS, interventricular septum; LV, left ventricle.