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Inadvertent temporary pacemaker lead placement in aortic sinus.

Naveen Garg1, Nagaraja Moorthy1

  • 1Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Heart Views : the Official Journal of the Gulf Heart Association
|April 4, 2014
PubMed
Summary

Improperly placed pacemaker leads can be dangerous. A case shows a lead in the aortic sinus still captured the heart, mimicking atrial pacing without fluoroscopy.

Keywords:
cardiac arrestcomplete heart blockcomplicationtemporary pacemaker implantation

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Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Temporary pacemaker lead implantation is crucial in managing cardiac arrest.
  • Absence of fluoroscopic guidance during lead placement increases the risk of malposition.
  • Abnormal lead placement can lead to serious complications and ineffective cardiac pacing.

Observation:

  • A case report details an elderly male patient who underwent temporary pacemaker lead implantation without fluoroscopic guidance due to cardiac arrest.
  • Following implantation, the pacemaker lead was identified in the non-coronary aortic sinus.
  • Despite the abnormal location, the lead successfully captured the myocardium.

Findings:

  • The pacemaker lead, despite being in the non-coronary aortic sinus, effectively captured the myocardium.
  • Post-pacing electrocardiography (ECG) findings mimicked those of appropriate atrial pacing.
  • This highlights a rare but significant complication of fluoroscopy-free temporary pacemaker lead placement.

Implications:

  • This case underscores the potential dangers of inadvertent pacemaker lead malposition, particularly in emergency settings without fluoroscopic guidance.
  • Physicians must be aware of the possibility of aortic sinus lead placement and its potential to mimic effective pacing on ECG.
  • Further research into safer techniques for emergency pacemaker lead placement is warranted to minimize such risks.