Saved by anticoagulants: Incidental discovery of a misplaced defibrillator lead 6 years after implantation. Inadvertent lead placement inside the left ventricular cavity

Abstract

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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

“…Leads in the LV can lead to dangerous thromboembolic events, which can occur anywhere from months to years after lead migration. 3 A misplaced ventricular lead must quickly be diagnosed to prevent adverse events, and thus, a high degree of scrutiny is required. The most important tool to recognize a lead in the LV is an ECG; on ventricular pacing, a misplaced lead will display a RBBB morphology rather than the expected left bundle branch block (LBBB).…”

“…Pacemaker implantation is a minimally invasive procedure, but still carries risks. Nearly a third of all complications are due to lead dislodgement or malposition 3 . A proper ventricular lead is one placed in the RV cavity; however, leads can migrate to the left ventricle (LV) through several pathways.…”

“…2 Permanent transvenous pacing system leads are guided through the left subclavian, cephalic, or axillary veins and eventually screwed into place in the right ventricle. 3 After placement, cardiac follow-up is necessary to rule out inadvertent lead placement, thromboembolic events, or other possible medical emergencies.…”

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

“…A misplaced pacing lead in the LV can be complicated by thromboembolic events, 10 Transvenous lead extraction can be considered because it is a definitive solution for the problem with less trauma. However, perioperative prevention of the thromboembolic event is of critical importance.…”

“…A misplaced pacing lead in the LV can be complicated by thromboembolic events, 10 endocarditis, and trauma to the LV wall and/or mitral valve. In our patient, the recurrent TIA was most likely the result of embolism of microthrombi, either formed around the misplaced pacing lead, or coming from the venous circulation and passing through the PFO which most likely was kept more open by the lead passing through it.…”