Images in Clinical Medicine

Malposition of Dual-Chamber Pacemaker Lead

Christian Firschke, M.D., and Bernhard Zrenner, M.D.

N Engl J Med 2002; 346:e2February 7, 2002

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Article

Figure 1 A 78-year-old man with a history of arterial hypertension and coronary artery disease was initially admitted to our hospital with atypical chest pain. Four years earlier, he had received a dual-chamber pacemaker because of sick sinus syndrome. His medications included aspirin, a beta-blocker, and an angiotensin-converting–enzyme inhibitor. An acute coronary syndrome was ruled out as the cause of his chest pain. Electrocardiography (Panel A) showed atrial and ventricular pacemaker spikes followed by a pattern of depolarization resembling that associated with right bundle-branch block, rather than the typical pattern of left bundle-branch block. Subsequent echocardiography demonstrated that a pacemaker lead crossed the interatrial septum, passed through the mitral valve, and entered the lateral left ventricular myocardium (arrows in Panel B), as shown in Panel C. AV denotes aortic valve, and AML anterior mitral-valve leaflet. No action was taken, since there had been no complications during the previous four years and the pacemaker and lead functions were normal.

Christian Firschke, M.D.
Bernhard Zrenner, M.D.
Deutsches Herzzentrum München, D-80636 Munich, Germany

Citing Articles (5)

Citing Articles

1. 1

   J. N. Irvine, D. J. LaPar, S. Mahapatra, J. P. DiMarco, G. Ailawadi. (2011) Treatment of a malpositioned transcutaneous ventricular pacing lead in the left ventricle via direct aortic puncture. Europace 13:8, 1207-1208
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2. 2

   Christof Kolb. (2007) Strategien zur Vermeidung und Behandlung von Komplikationen der Herzschrittmacherimplantation. Herzschrittmachertherapie & Elektrophysiologie 18:4, 234-242
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3. 3

   Mehmet K Aktas, Abrar H Shah, Toshio Akiyama. (2007) Atrioventricular Pacemaker Leaf Reversal. Journal of Arrhythmia 23:1, 69-72
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4. 4

   MATTHIAS OVERBECK, CHRISTOF KOLB, CLAUS SCHMITT, ALBERT SCHOMIG, RUDIGER LANGE. (2005) Accidental Transarterial Implantation of Dual Chamber Pacemaker Leads in the Left Ventricle and the Right Coronary Artery. Pacing and Clinical Electrophysiology 28:5, 469-471
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5. 5

   (2002) Malposition of a Pacemaker Lead. New England Journal of Medicine 346:25, 2010-2010
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