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Patent foramen ovale. Correct route for implantation of a biventricular permanent pacemaker?
T Schroeter1, M A Borger, F W Mohr
1Department of Cardiac Surgery, Herzzentrum Leipzig, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. Thomas-Schroeter@gmx.de
Introduction:
Intentional or unintentional placement of a pacemaker lead into the left ventricle is an uncommon clinical entity that is associated with a high risk for systemic embolization and enormous difficulties in case of explantation. Unintentional implantation through a patent foramen ovale via the mitral valve is the usual pathway for this malposition.
Methods:
We report a case where a pacemaker lead was placed intentionally into the left ventricle via a patent foramen ovale for biventricular pacing for resynchronization therapy. Later, the patient developed life-threatening pacemaker lead-associated endocarditis with sepsis. Emergency open heart surgery for lead removal was necessary in the form of a reoperation after bypass graft surgery a number of years earlier.
Conclusion:
Although it is technically feasible to implant the pacemaker lead into the left ventricle via a patent foramen ovale, we consider this option to be obsolete for use with a biventricular pacemaker, due to the multitude of risks, which can, in part, be life-threatening for the patient.
