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Pacemaker electrode misplaced in the left ventricle.

André Luiz Cerqueira de Almeida¹, Viviane Machicado Cavalcante, Márcio Diego Castro Teixeira

¹Universidade Estadual de Feira de Santana, Hospital EMEC, BA, Brasil. andrealmeida@cardiol.br

Arquivos Brasileiros De Cardiologia

|October 15, 2010

Summary

A VVI pacemaker electrode was found implanted abnormally in the left ventricle (LV) two years after placement in a patient with Chagas disease. This case highlights unusual pacemaker lead migration and its diagnostic imaging findings.

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Area of Science:

Cardiology
Medical Imaging
Electrophysiology

Background:

Pacemaker implantation is a common procedure for managing bradyarrhythmias.
Lead dislodgement or malposition can occur, necessitating careful diagnostic evaluation.
Chagas disease presents unique challenges in cardiac device management.

Observation:

A 65-year-old female patient with Chagas disease presented with a right bundle branch block pattern on ECG.
Chest X-ray revealed an unusually curved pacemaker electrode path.
Transthoracic echocardiography confirmed anomalous electrode placement in the left ventricle.

Findings:

The VVI pacemaker electrode migrated through the right atrium, across the atrial septum, into the left atrium, through the mitral valve, and deployed in the left ventricle.
Diagnostic imaging (ECG, X-ray, echocardiography) was crucial in identifying the malposition.
Potential deployment routes, clinical presentation, and imaging characteristics of anomalous lead placement were analyzed.

Implications:

This case underscores the importance of comprehensive post-implantation evaluation, especially in patients with complex cardiac conditions.
Understanding rare lead migration pathways is vital for preventing complications and optimizing device therapy.
Accurate diagnosis through multimodal imaging is essential for guiding appropriate management strategies.