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Inadvertent transarterial pacemaker lead placement.

Ravi R Bajaj1, Neil Fam2, Sheldon M Singh3

  • 1Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Canada; Schulich Heart Center, Sunnybrook Health Sciences Center, Toronto, Canada.

Indian Heart Journal
|October 4, 2015
PubMed
Summary

A pacemaker lead migrated from the right ventricle to the left ventricle and subclavian artery, causing stroke symptoms four months after insertion. Routine cardiac imaging is crucial for detecting pacemaker lead malposition.

Keywords:
ArtificialBundle-branch blockPacemakerPost-operative complicationsStroke

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Neurology

Background:

  • Pacemaker insertion is a common procedure for managing bradyarrhythmias.
  • Lead malposition can occur, potentially leading to complications.

Observation:

  • A 73-year-old patient developed left-sided hemiparesis four months post-right ventricular pacemaker insertion.
  • Electrocardiogram showed a paced RBBB complex and chest X-ray revealed abnormal lead path.

Findings:

  • Echocardiography and CT confirmed left ventricular pacemaker malposition.
  • The lead had retrogradely passed into the punctured subclavian artery.

Implications:

  • This case highlights the importance of routine cardiac investigations after pacemaker insertion.
  • Early detection of lead malposition can prevent serious neurological complications like stroke.
  • Management strategies for identified lead malposition are discussed.