Key result
Retaining a malpositioned ventricular lead in the middle cardiac vein successfully manages misdiagnosed lead perforation.
Case Report (n=1)
This case highlights the importance of accurately distinguishing between ventricular lead perforation and inadvertent malposition into the middle cardiac vein to avoid unnecessary lead extraction.
Undetected lead perforation may manifest years later without follow-up; case report leaves open optimal surveillance intervals.
A 54-year-old man had a dual-chamber pacemaker implantation 9 years ago because of sick sinus syndrome at a different facility. The patient did not undergo any evaluation of his pacemaker for a long time with cardiologist. The patient was admitted to another hospital manifesting dyspnea and palpitation with atrial fibrillation for 1 month, and he was diagnosed with ventricular lead perforation. For further treatment, he was referred to our hospital, and an elective replacement indicator (ERI) of the battery state and a malpositioned ventricular lead into the middle cardiac vein were found. Finally, the pacing lead was left in the primary place and the pacemaker was replaced.
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Chen et al. (2022) conducted a case report in Malpositioned ventricular lead misdiagnosed as lead perforation (n=1). Pacemaker replacement with retention of the malpositioned lead was evaluated. A malpositioned ventricular lead into the middle cardiac vein was misdiagnosed as lead perforation and successfully managed by leaving the lead in place and replacing the pacemaker.
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