Removal of Misplaced Left Ventricular Single Lead Pacemaker in a Patient Presenting with Recurrent Transient Ischemic Attacks

Abstract

Over 200,000 cardiac electronic implantable devices are annually placed in individuals living within the United States. Complications from this procedure can range up to 12%. Inadvertent lead placement into the left ventricle is a rare but recognized complication of implantable cardiac electronic devices. This is a retrospective case report of a female patient in her late 70's who underwent atrioventricular node ablation and misplacement of single lead pacemaker, subsequently presenting with recurrent transient ischemic attacks one month later. Initial electrocardiogram and chest X-ray demonstrated misplacement of her pacemaker in the left ventricle. Medical therapy was attempted, however, patient subsequently underwent extraction via aortotomy with implantation of epicardial pacemaker. Inadvertent placement of implantable electronic cardiac devices is a rare but well recognized complication. A post-procedure electrocardiogram and chest X-ray should be routinely performed to confirm appropriate lead placement. Procedures to manage this complication are evolving with novel device therapies specifically designed for percutaneous lead extraction.

A Series of Unfortunate Events: Long-neglected Malpositioned Pacemaker and its Consequences

“…However, if anticoagulation therapy is ineffective and thromboembolic complications occur, surgical intervention must be considered. 7 In our case, surgical extraction was needed due to infected pacemaker pocket and because of the mitral regurgitation that was caused by the misplaced ventricular lead.…”

A series of unfortunate events: Long‐neglected malpositioned pacemaker and its consequences

“…Anticoagulation therapy is currently the most popular method of treatment. However, if anticoagulation therapy is ineffective and thromboembolic complications occur, surgical intervention must be considered 8 . In our case, surgical extraction was needed due to infected pacemaker pocket and because of the mitral regurgitation that was caused by the misplaced ventricular lead.…”

Successful percutaneous extraction of malpositioned pacemaker lead in the left ventricle after proper dabigatran treatment

“…Since then, stimulation of the LV has been reported due to the passage of the pacing lead through an atrial‐septum defect, a PFO, or a sinus venosus defect. Other possibilities include perforation of the inter‐ventricular septum, and erroneous introduction of the pacing lead into the subclavian artery and placement in the LV across the aortic valve 6 . Abnormal thoracic anatomy (e.g., scoliosis), underlying congenital heart disease, and implantation performed by an inexperienced operator could be the predictors of misplaced pacing lead in the LV 7 …”

“…Other possibilities include perforation of the inter-ventricular septum, and erroneous introduction of the pacing lead into the subclavian artery and placement in the LV across the aortic valve. 6 Abnormal thoracic anatomy (e.g., scoliosis), underlying congenital heart disease, and implantation performed by an inexperienced operator could be the predictors of misplaced pacing lead in the LV. 7 Chest radiography and a 12-lead surface ECG are the sensitive markers for a misplaced pacing lead and are often the first reason for suspicion.…”