Inadvertent Placement of Pacing Leads Into the Left Ventricle

A 65-year-old male with a history of paroxysmal atrial fibrillation and sinus node dysfunction underwent dual chamber pacemaker implantation 4 years ago. He presented to the emergency department with acute onset dysarthria and left facial droop. Although non contrast computed tomography of the head was unremarkable for acute changes, magnetic resonance imaging of the brain revealed multiple small acute and chronic infarcts in the midline superior cerebellum, posterior right parietal, and right midfrontal lobes. The patient had been on apixaban for secondary prevention of stroke but had recurrent strokes. With the multifocal distribution of cerebral infarcts, cardioembolic source was suspected. Further evaluation was pursued to determine the underlying etiology.