Transvenous permanent left ventricular pacing. A case report

Inadvertent defibrillator lead placement into the left ventricle after MitraClip implantation: A case report

RATIONALE

Inadvertent pacemaker/defibrillator lead placement into the left ventricle is an unusual cardiac device-related complication and its diagnosis is not always easy and often misunderstood. Thromboembolic events are frequently associated with this procedural complication. Percutaneous lead extraction should be performed when diagnosis is made early after device implantation while long-life oral anticoagulation is a wise option when the diagnosis is delayed and the lead is not removed.

PATIENT CONCERNS

A 65-year-old man affected by dilated cardiomyopathy, previously treated with a percutaneous mitral valve repair, with 2 MitraClip devices, and later with dual chamber cardioverter/defibrillator implantation, returned in outpatient clinics 2 months after discharge for deterioration of dyspnea; transthoracic echocardiography revealed that the shock lead had been accidentally placed in the apex of the left ventricle.

DIAGNOSES

The unintentional lead malposition through the iatrogenic atrial septal defect and its presence into the mitral valve orifice, together with the 2 clip devices implanted, generated an acceleration of transvalvular diastolic flow, determining a moderate stenosis of the mitral valve, as well as promoting a worsening of the degree of valvular regurgitation.

INTERVENTIONS

Oral anticoagulation therapy was started and a mechanical lead extraction was percutaneously performed. A new defibrillator lead was later appropriately positioned in the apex of the right ventricle.

OUTCOMES

The patient was discharged 3 days after intervention and the follow-up, performed 1 month after discharge, was uneventful.

LESSONS

Complex interventional procedures and implantation of multiple devices can increase procedural troubles and the risk of mechanical complications related to pacemaker/defibrillator implantation. Careful observation of the QRS complex morphology on the electrocardiogram (ECG), during paced rhythm, and the achievement of the echocardiographic examination, in the postprocedural phase, allow an early diagnosis of lead malposition.

Two-Dimensional Echocardiography for the Diagnosis of Interventricular Septum Perforation by a Temporary Pacing Catheter

This case study describes a patient with complete heart block inadvertently paced from the left ventricular posterior wall due to perforation of interventricular septum by a temporary pacing catheter. This is a rare but potentially fatal complication of pacing. The frontal chest radiograph neither identified abnormalities nor could determine the exact site of the catheter tip. The electrocardiogram revealed a right bundle branch block pattern. Echocardiography was performed immediately at bedside and the diagnosis was made. The temporary pacing catheter was removed without complications and, the next day, the patient underwent permanent pacemaker implantation. Given its noninvasiveness and availability, echocardiography is a highly effective means of assessing pacemaker complications such as catheter perforation.

An Unusual Case of Embolic Stroke: A Permanent Ventricular Pacemaker Lead Entirely Within the Arterial System Documented by Transthoracic and Transesophageal Echocardiography

A pacemaker lead in the left ventricle is a rare complication of implantation. Recognition of this complication is important because thromboembolic events are associated. We report the first case, to our knowledge, of a patient who had a permanent pacemaker implanted via the left subclavian artery to the left ventricle, which is documented by electrocardiography, chest radiography, thoracic echocardiography, and transesophageal echocardiography.