Key result
Anticoagulation and watchful waiting yield ~18-year complication-free survival after inadvertent LV ICD lead placement.
Why the study?
Inadvertent lead malposition in the left heart during ICD implantation is a recognized complication with limited evidence on management.
Case Report (n=1)
A watchful-waiting strategy with anticoagulation may be a viable long-term approach for inadvertent left-sided ICD lead placement.
Answers are grounded in this paper and cite their sources.
May support conservative management in select inadvertent LV ICD lead cases; hypothesis-generating and should not yet change practice.
Implantable cardioverter defibrillators (ICDs) are recommended for primary or secondary prevention in multiple cardiac conditions.One of the recognised complications during implantation of cardiac implantable electronic device (CIED) is inadvertent lead malposition in the left heart (ILMLH), which can lead to further thromboembolism and infective endocarditis.In this paper, we present a unique case of a patient who had an accidental ICD lead implanted into the left ventricle via an atrial septal defect (ASD).Evidence on the management of such a complication is rare.A watchful-wait approach with appropriate anticoagulation was adopted here, resulting in an uneventful 18year survival.We also navigate through the current evidence on the recognition and management of such cases.
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Elboraey et al. (2026) conducted a case report in Inadvertent lead malposition in the left heart (n=1). Watchful-wait approach with appropriate anticoagulation was evaluated on Survival and complications. A watchful-wait approach with appropriate anticoagulation for an accidental left ventricular ICD lead placement resulted in an uneventful 18-year complication-free survival.
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