Related Experiment Videos
Amaurosis fugax in a patient with a left ventricular endocardial pacemaker
Insights
A misplaced pacemaker catheter can cause arterial embolization. Echocardiography diagnosed a transvenous left ventricular endocardial pacemaker catheter embolizing to the eye, leading to surgical removal.
Area of Science:
- Cardiology
- Medical Devices
- Diagnostic Imaging
Background:
- Transvenous pacemaker lead placement carries risks, including systemic arterial embolization.
- Left ventricular endocardial pacing is an alternative to epicardial pacing in specific cases.
- Amaurosis fugax can be caused by embolic events, necessitating thorough investigation of potential sources.
Observation:
- A patient with a history of myocardial infarctions and tachycardia-bradycardia syndrome presented with left-eye amaurosis fugax.
- Initial investigations, including carotid angiography, did not fully explain the embolic event.
- Chest x-ray and electrocardiogram suggested pacemaker catheter malposition.
Findings:
- M-mode and two-dimensional echocardiography revealed a transvenous pacemaker catheter crossing the atrial septum and mitral valve.
- The catheter was found to be implanted in the left ventricular endocardium.
- Surgical removal of the misplaced pacemaker catheter was successfully performed.
Implications:
- This case highlights the potential for pacemaker catheter malposition to cause serious embolic complications.
- Echocardiography is a valuable tool for diagnosing pacemaker lead abnormalities and malposition.
- Understanding the causes of right bundle branch block patterns in pacing is crucial for accurate diagnosis and management.
Abstract:
A transvenous left ventricular endocardial pacemaker catheter is a potential source of systemic arterial embolization. The case of a woman who presented with left-eye amaurosis fugax is reported. The patient had a history of contralateral carotid atherosclerosis; however, the digital subtraction angiography of the carotid arteries was not sufficiently abnormal to account for her present symptoms. The patient had a history of two myocardial infarctions and the tachycardia-bradycardia syndrome for which she was treated with a demand ventricular pacemaker. The chest x-ray and electrocardiogram suggested pacemaker catheter malposition. By M-mode and two-dimensional echocardiography, the catheter was shown to cross the atrial septum and the mitral valve to implant in the left ventricular endocardium. The approach to diagnosis and therapy that led to surgical removal of the pacing catheter is presented. The causes of the electrocardiographic right bundle branch block pattern in cardiac pacing and the usefulness of echocardiography in evaluating pacing catheters are discussed.