[Perforation of a temporary transvenous pacemaker electrode in the left hemithorax. Diagnostic value of...

We report a rare malposition of a temporary transvenous pacemaker electrode. A pacemaker electrode was inserted in a patient with acute postero-lateral infarction. The correct position of the electrode tip was controlled by fluoroscopy. Capture and sensing functions worked regularly. Four days later, angina-pectoris-like complaints occurred again. Chest x-ray film revealed the tip of the electrode in the left hemithorax. Echocardiographic assessment showed a penetration through the interventricular septum into the left ventricle. The electrode passed the left ventricle, penetrated the anterior-lateral free wall and reached the left pleural space. A thoracotomy was performed immediately. The electrode was retracted under visual control. A spurting arterial bleeding from the left ventricle was secured with a purse-string ligature. This case report emphasizes the value of echocardiography in the evaluation of a malposition of a transvenous pacemaker electrode.