Printer Friendly

Visual diagnosis in cardiology: malposition of dual-chamber pacemaker lead.

A 78-year-old woman was seen in our clinics for routine pacemaker follow-up. In 1995 she had received a dual-chamber pacemaker after His bundle ablation for symptomatic drug-refractory atrial fibrillation with consecutive third degree atrioventricular block.

A 12-lead electrocardiograph (Figure 1) showed atrial fibrillation with ventricular pacemaker spikes associated with right bundle-branch block, rather than the typical pattern of left bundle-branch block. A subsequent chest X-ray displayed the atrial lead in proper position and the ventricular lead well within the left ventricular silhouette (Figure 2). Subsequent transthoracic echocardiography demonstrated that the pacemaker lead was crossing the interatrial septum, passing through the mitral valve and entering the lateral left ventricular myocardium. Figure 3 shows a monitor strip during battery exchange with the patient's own rhythm (left axis deviation) followed by VVI stimulation by the newly connected pacemaker, showing an unusual right axis deviation.

This lead malposition was initially detected four years after the implantation in 1999 by a routine chest X-ray for tuberculosis screening. The lead was placed in the left ventricle at that time through a persistent foramen ovale. After detection of the lead malposition the risk of surgical lead extraction was weighed against the possible risk of systemic thromboembolism and the need of long-term anticoagulation. The patient opted against an operative correction and a warfar in sodium therapy was initiated. Since then she has lived without evidence of neurological deficiencies or peripheral embolic phenomena.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

[FIGURE 3 OMITTED]

Reference

(1.) Ciolli A, Trambaiolo P, Lo Sardo G, Sasdelli M, Palamara A. Asymptomatic malposition of a pacing lead in the left ventricle: The case of a woman untrated with antcoagulant therapy for eight years. Ital Heart J 2003; 4:562-564.

H. WEDEKIND

Hamm, Germany

J. G. MULLER

Vermont, United States
COPYRIGHT 2007 Australian Society of Anaesthetists
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2007 Gale, Cengage Learning. All rights reserved.

 
Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Correspondence
Author:Wedekind, H.; Muller, J.G.
Publication:Anaesthesia and Intensive Care
Article Type:Case study
Geographic Code:1USA
Date:Oct 1, 2007
Words:294
Previous Article:Levosimendan in acute pulmonary embolism.
Next Article:Excision of a teratomatous 'parasitic twin' in an infant with uncorrected complex cyanotic heart disease.
Topics:


Related Articles
Staphylococcus lugdunensis pacemaker-related infection.
Pacemaker reduces pacing.
Right ventricular pacing triggers heart failure: pacemaker users had 44% higher rate of HF death, hospitalization.
Atrial pacing ineffective in obstructive sleep apnea, hypopnea.
Pacing in obstructive hypertrophic cardiomyopathy: a therapeutic option?/Hipertrofik kardiyomiyopatide pacing: Terapotik opsiyon mu?
Clinical impact of surface electrocardiography of cardiac arrhythmias in pacemaker-ICD patients.
Pacemaker lead failure due to crush injury / Ezilme hasarina bagli kalici kalp pili elektrod kusuru.
Interventricular septal perforation as a rare complication of temporary transvenous pacemaker/Gecici transvenoz pacemaker'in nadir bir komplikasyonu:...

Terms of use | Privacy policy | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters