Przypadkowe umieszczenie elektrody stymulatora w lewej komorze serca u pacjenta z przetrwałym otworem owalnym – przypadek kliniczny

Abstract

The random placement of pacing lead in the left ventricle (LV) is a rare and late diagnosed complication of the permanent heart stimulation. In most cases the intracardiac electrode moves through the interatrial septum or through the patent foramen ovale to the LV. On ECG the sets of QRS have morphology of right bundle branch block. The decisive survey used to identify this complication is echocardiography, especially transesophageal study. The malposition of the pacing electrode is associated with the risk of thromboembolic complications. The treatment consists of early lead removal. In case of lack of such a possibility the chronic anticoagulation treatment has to be started. The paper presents a case of incorrect position of pacing electrode in LV in a patient with PFO.Key words: cardiac pacing, inadvertent left ventricular pacing, lead removal, anticoagulation therapy Folia Cardiologica 2016; 11, 6: 535-538 Case reportA 74-year-old male was admitted to the Department of Cardiology, due to atrioventricular arrhythmia (second degree atrioventricular block 2: 1) with MAS syndrome. During hospital admission the patient was secured by a temporary transvenosus pacing electrode. The next day the DDDR pacemaker was implanted. After surgery, on ECG recording right bundle branch block (RBBB) configuration of paced complexes were present ( Figure 1A). The chests X-ray in posterior-anterior (PA) and lateral projections were correct (Figure 2). The transthoracic echocardiography showed wrong location of pacing lead in the left ventricle (pacing electrode passed from the right atrium by the foramen ovale into the left atrium and then through the mitral valve into the left ventricle of the side wall) (Figure 3). To confirm a malposition of the electrode and to exclude possible artifacts, the transesophageal echocardiography was done. It also showed an incorrect position of ventricular electrode (Figure 4), current patent foramen ovale (PFO) and a trace of the left-to-right leak through the interatrial septum around the passage of the lead ( Figure 5). The next day of hospitalization repositioning ventricular electrode was done. After the procedure, the control ECG showed normal right ventricular stimulation with left bundle branch block (LBBB) ( Figure 1B). The echocardiography showed the correct location of the pacemaker electrodes, there was no damage to the structures of the heart or leakage through the septum. Control stimulation parameters were correct. DiscussionThe pacemaker implantation is the most common surgery in the invasive cardiology. Doctors are more often faced