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A stroke of bad luck: left ventricular pacemaker malposition
Scott Reising1, Robert Safford, Ramon Castello
1Department of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA.
Summary
Pacemaker lead malposition, though rare, can cause serious complications like stroke. Early detection via electrocardiography and imaging is crucial for timely, minimally invasive intervention, especially in high-risk patients.
Area of Science:
- Cardiology
- Medical Devices
- Neurology
Background:
- Lead wire malposition during pacemaker implantation is an underreported complication.
- Lack of consistent reporting obscures the true incidence and prevalence of lead malposition.
- Available safeguards against lead malposition are underutilized despite their effectiveness and low cost.
Purpose of the Study:
- To highlight a case of pacemaker lead malposition presenting as stroke.
- To emphasize the diagnostic utility of electrocardiography and imaging in identifying lead malposition.
- To discuss the appropriate management strategy for lead malposition, considering patient comorbidities.
Main Methods:
- Case presentation of an 80-year-old male with stroke post-pacemaker placement.
- Diagnostic workup included computed tomography, electrocardiography, chest radiography, and transesophageal echocardiography.
- Management involved transcatheter lead extraction and replacement pacemaker insertion.
Main Results:
- The patient presented with stroke symptoms attributed to a malpositioned pacemaker lead extending into the left ventricle.
- Electrocardiography showed right bundle-branch block morphology, and radiography suggested malposition.
- Transesophageal echocardiography confirmed lead traversal of the aortic valve without thrombus.
- Successful transcatheter lead removal and pacemaker replacement were performed.
Conclusions:
- Pacemaker lead malposition can lead to neurological complications such as ischemic stroke.
- A systematic diagnostic approach involving ECG, radiography, and echocardiography is essential for identifying lead malposition.
- Transcatheter lead extraction is a viable and less invasive option for selected patients, particularly those with contraindications to open-heart surgery.
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