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[Left ventricular insertion of a permanent pacemaker (radiographic aspect)]
G Ferretti1, P Defaye, F Thony
1Service Central de Radiologie et Imagerie Médicale, CHU Grenoble.
Journal De Radiologie
|December 1, 1995
Summary
A rare pacemaker complication occurred when the lead inadvertently paced the left ventricle, undetected by standard imaging or ECG. Diagnosis was delayed until mitral valve damage manifested two months post-implantation.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Permanent pacemaker implantation is a common procedure for bradyarrhythmias.
- Transarterial lead placement is the standard approach for pacemaker insertion.
- Routine post-procedure imaging and electrocardiograms (ECGs) are used to confirm correct lead placement.
Observation:
- A case of inadvertent transarterial permanent pacing of the left ventricle is presented.
- The lead malposition was not identified on initial chest radiography or ECG.
- Diagnosis was made two months after implantation due to rupture of the mitral valve chordae.
Findings:
- The malpositioned pacemaker lead caused significant cardiac damage.
- Standard diagnostic methods failed to detect the lead's aberrant placement.
- The rupture of mitral valve cordage was the presenting sign of the malposition.
Implications:
- This case highlights a rare but serious complication of pacemaker implantation.
- It underscores the limitations of routine chest radiography and ECG in diagnosing lead malposition.
- Emphasizes the importance of recognizing specific radiographic findings for diagnosing such rare malpositions.
- Suggests potential need for advanced imaging in select cases to confirm lead placement and prevent complications.