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- Title
Malposition of Transvenous Pacing Lead in the Left Ventricle.
- Authors
Ghani, Mansura; Thakur, Ranjan K.; Boughner, Derek; Morillo, Carlos A.; Yee, Raymond; Klein, George J.
- Abstract
Ventricle. Malposition of pacemaker leads has been described in several locations but rarely in the left ventricle. The incidence and clinical course of this pacemaker complication are unknown. We describe clinical, electrocardiographic, chest X ray, and echocardiographic findings in four patients in whom the transvenous pacing lead was inadvertendy placed through the interatrial septum and mitral valve into the left ventricle, in these patients, lead misplacement was not recognized at the time of implantation and lead malposition was diagnosed a mean of 2 years later. All four patients had right bundle branch block configuration paced complexes. In retrospect, chest X rays suggested a typical lead position in all, but the initial posterioranterior and lateral chest X rays were misinlerpreled and contributed to the delay in diagnosis. When lead misplacement in (he left ventricle was considered it was confirmed by two-dimensional echocardiography. One patient subsequently presented with a stroke and the remainder were diagnosed when they presented with other unrelated problems. Pacing thresholds were normal at the time of implantation and behaved normally during follow-up. The patient presenting with stroke was anticoagulated and the other three have been managed expectantly without anticoagulation. Diagnosis of left ventricular lead malposition is not difficult but requires a high index of suspicion. A 12-lead ECC and posterior-anterior and lateral chest X rays after implantation can be diagnostic. Patients with pacing lead in the left ventricle may remain asymptomatic with normal lead function during long-term follow-up. Anticoagulation should be considered when this problem comes to attention for the first time during follow-up.
- Subjects
CARDIAC pacing; ARRHYTHMIA treatment; ELECTRIC stimulation; CARDIAC pacemakers; IMPLANTED cardiovascular instruments; MEDICAL equipment
- Publication
Pacing & Clinical Electrophysiology, 1993, Vol 16, Issue 9, p1800
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/j.1540-8159.1993.tb01814.x