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[A rare cause of stroke in a patient with a cardiac pacemaker]
P Laury1, J P Chabert, C Blaise
1Département de cardiologie, hôpital Robert Debré, 51092 Reims. patrice.laury@wanadoo.fr
Insights
A dislodged pacemaker catheter in the left ventricle, a rare complication, was diagnosed via echocardiography. The catheter was successfully repositioned to prevent stroke risk.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Pacemaker implantation is a common procedure for cardiac rhythm management.
- Ventricular pacing leads are typically placed in the right ventricle.
- Complications, though rare, can occur, necessitating prompt diagnosis and management.
Observation:
- A 78-year-old woman presented with recurrent cerebrovascular accidents.
- Initial investigations were unremarkable.
- A pacemaker patient was found to have a displaced ventricular pacing catheter in the left ventricle via a patent foramen ovale.
Findings:
- Diagnosis was suspected based on clinical presentation and echocardiography.
- Transthoracic and transesophageal echocardiography confirmed the catheter displacement.
- The displaced catheter posed a risk of systemic embolism.
Implications:
- Accurate diagnosis of lead misplacement is crucial for preventing embolic events.
- Echocardiography plays a vital role in identifying cardiac device complications.
- Endovascular repositioning of the pacing catheter in the right ventricle is a viable treatment option.
Abstract:
The authors report the case of a 78 year old woman admitted to hospital for recurrent cerebrovascular accidents, the initial investigation of which was normal. This pacemaker patient had a displacement of the definitive ventricular pacing catheter which was positioned in the left ventricle through a patent foramen ovale. The diagnosis was suspected on clinical and echocardiographic examination and confirmed by transthoracic and transoesophageal echocardiography. In view of the risk of systemic embolism, the pacing catheter was repositioned by an endovascular approach in the right ventricle.