Iatrogenic endocardial injury associated with preexisting atrial abnormalities

Considering the rising number of cardiac catheterization and pacemaker placement procedures being performed each year, it is likely that increasing numbers of deaths associated with complications from these procedures will require certification by the medical examiner. We report 2 cases of iatrogenic atrial injury related to pacemaker placement in which a preexisting cardiac abnormality increased the risk of such complications. One case was associated with an embryologic remnant known as Chiari's network, and the other case was associated with lipomatous hypertrophy of the interatrial septum. The identification of an anatomic abnormality, which results in a predisposition to iatrogenic injury may decrease the risk of costly or unnecessary litigation commonly associated with these deaths.