Targeted LV endocardial pacing is a potential alternative to CS pacing and warrants a trial to characterize long-term benefits and risks.

ICD implant rates are affected by hospital type and are significantly higher in regional centres when compared with DGHs. To increase ICD implant rates, the widespread implementation of clinical pathways to identify prospective primary prevention patients may be needed.

Inadvertent placement of a pacemaker lead in the left ventricle (LV) is a rare complication of pacing. We describe a case of inadvertent LV pacing where the ventricular lead traversed the mediastinum and accessed the heart through the posterior wall of the left atrium. Both transesophageal echo and venography were useful in understanding the course of the misplaced lead, which was removed percutaneously without complication.