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An unusual cause of transient ischemic attack in a patient with pacemaker

Jagadeesh Kumar Kalavakunta1, Vishal Gupta2, Basil Paulus2

  • 1Division of Cardiology, Michigan State University, 804 Service Road, A205 Clinical Center, East Lansing, MI, 48824, USA.

Case Reports in Cardiology
|May 15, 2014
PubMed

Insights

Pacemaker lead malposition in the left ventricle is a rare complication. Diagnosis requires clinical suspicion, and asymptomatic cases may be managed with anticoagulation instead of lead removal.

Area of Science:

  • Cardiology
  • Medical Devices

Background:

  • Pacemaker lead malposition is a known complication.
  • Left ventricular lead malposition is rare and often underdiagnosed.

Purpose of the Study:

  • To report a case of left ventricular pacemaker lead malposition.
  • To highlight diagnostic challenges and management strategies.

Main Methods:

  • Case presentation of a 77-year-old male with atrial fibrillation and pacemaker.
  • Electrocardiogram (ECG) interpretation revealing atypical right bundle-branch block pattern.
  • Diagnostic confirmation using chest X-ray and echocardiogram.

Main Results:

  • Pacemaker lead was confirmed in the left ventricle, not the right.
  • Patient presented with transient ischemic attack while on warfarin with subtherapeutic INR.
  • Patient refused surgical lead removal, opting for increased warfarin dosage.

Conclusions:

  • Left ventricular lead malposition requires a high index of clinical suspicion for diagnosis.
  • Echocardiography is key for identifying lead position.
  • Asymptomatic patients may be candidates for lifelong anticoagulation over surgical intervention.

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