Inadvertent Placement of Pacing Leads Into the Left Ventricle

Area of Science:

• Neurology
• Cardiology
• Radiology

Background:

• A 65-year-old male with a history of paroxysmal atrial fibrillation and sinus node dysfunction presented with acute neurological deficits.
• The patient had a dual-chamber pacemaker implanted 4 years prior and was on apixaban for stroke prevention.
• Despite anticoagulation, the patient experienced recurrent strokes.

Purpose of the Study:

• To investigate the cause of recurrent strokes in a patient with known atrial fibrillation and pacemaker.
• To determine the underlying etiology of multifocal cerebral infarcts despite anticoagulation therapy.

Main Methods:

• Clinical presentation and history review.
• Non-contrast computed tomography (CT) of the head.
• Magnetic resonance imaging (MRI) of the brain.

Main Results:

• MRI revealed multiple small acute and chronic infarcts in the cerebellum, parietal, and frontal lobes.
• The distribution of infarcts suggested a multifocal embolic source.
• Initial CT head scan was unremarkable for acute changes.

Conclusions:

• A cardioembolic source was suspected due to the multifocal infarct distribution.
• Further evaluation is necessary to identify the specific etiology of recurrent strokes.