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Transvenous pacemaker electrodes placed unintentionally in the left ventricle: three cases
1Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK.
Postgraduate Medical Journal
|February 1, 1989
Summary
Pacemaker electrodes can be misplaced into the left ventricle, delaying diagnosis. Right bundle branch block on ECGs suggests this serious complication, requiring imaging for confirmation.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Pacemaker lead placement is a critical procedure in cardiac rhythm management.
- Accurate lead positioning is essential for effective pacing and to prevent complications.
Observation:
- Three cases of unintentional left ventricular (LV) pacemaker electrode placement are presented.
- Two involved retrograde arterial insertion of temporary wires, one causing acute arterial obstruction.
- One permanent lead traversed the atrial septum via a patent foramen ovale into the LV.
Findings:
- Electrocardiograms (ECGs) in all patients showed paced complexes with a right bundle branch block (RBBB) morphology.
- This specific ECG pattern should prompt suspicion of LV lead placement.
- Chest radiographs and echocardiography are crucial for confirming lead position.
Implications:
- Delayed recognition of LV lead misplacement can lead to significant complications.
- RBBB on paced ECGs is a key indicator for further diagnostic imaging.
- Prompt diagnosis and intervention are vital for patient safety and optimal pacemaker function.