Why the study?
As ICD implants increase, recognizing complications such as inadvertent lead malposition is critical because it is frequently underdiagnosed and can cause endocardial damage and thrombotic events.
Case Report (n=1)
An ECG showing a RBBB pattern during VVI pacing should raise suspicion of inadvertent incorrect placement of a pacing/ICD lead, highlighting the importance of echocardiography for confirmation.
Implantable cardiac defibrillators (ICDs) are a popular and effective option in heart failure with left ventricular systolic dysfunction patients. Although frequently underdiagnosed, inadvertent malposition can lead to endocardial damage and thrombotic events. As ICD implants tend to increase in the following years, the recognition of their complications is critical. The authors present a case of a 64-year-old female with advanced heart failure and ICD malposition. This accidental discovery was denounced by the presence of a right bundle branch block (RBBB) pattern and later confirmed by echocardiography which showed the lead tip in contact with the midsegment of the left ventricular anterolateral wall. As the patient's hospitalization was complicated with refractory ascites and cardiogenic shock, she underwent cardiac transplantation, with no recurrence of heart failure symptoms. An electrocardiogram showing a RBBB pattern during VVI pacing should arise the suspicion of inadvertent incorrect placement of a pacing/ICD lead. The many facets of echocardiography should be used for the diagnosis of this complication, as they were paramount in this case, as highlighted.
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Ferreira et al. (2020) conducted a case report in Heart failure with ICD malposition (n=1). Implantable cardiac defibrillator (ICD) placement was evaluated.
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