Sinus venosus atrial septal defect: a rare cause of misplacement of pacemaker leads

Abstract

Routine implantation of pacemakers and implantable cardioverter defibrillators is not commonly associated with complications. However, in some cases we see misplacement of pacemaker leads which is most often related to the presence of underlying cardiac anomalies. We report the case of misplacement of a pacemaker lead into the left ventricle of a 56-year-old patient paced in VVI/R mode and with a tined type pacemaker lead because of a symptomatic complete atrioventricular block. Electrocardiogram showed a pacemaker-generated rhythm with a right bundle branch block pattern. Chest X-ray showed the pacemaker lead located relatively high in relation to the diaphragm. Echocardiography visualized the pacemaker lead in the left heart chambers (atrium and ventricle), hence confirming its aberrant course. Further, the defect causing its passage to the left heart chambers was a sinus venosus atrial septal defect. The patient reported no complication related to the misplacement of the lead. After a brief period of oral anticoagulation, the lead was inserted into the right ventricle by percutaneous technique.

Sinus Venosus Atrial Septal Defect as an Overlooked Source of Shortness of Breath Among Patients With Pulmonary Arterial Hypertension

“…SVASD can remain undiagnosed for years as symptoms may not present until adulthood, often manifesting as exercise intolerance and dyspnea. Other symptoms include arrhythmias, paradoxical emboli, and inadvertent passage of cardiovascular leads or catheters through the defect during interventions [ 14 ]. Patients can develop pulmonary hypertension due to left-to-right shunting, which is more pronounced in SVASD with PAPVR, potentially leading to an earlier onset of Eisenmenger physiology.…”

The Sinus Venosus Veno-Venous Bridge

“…Some patients have only come to attention when pacing leads or catheters were noted to enter the left-sided chambers during cardiac interventions. 11 Significantly, the left-to-right shunt caused by the veno-venous bridge is usually larger when compared to that produced by deficiencies within the oval fossa. This is due, in part, to the anomalous pulmonary venous connection contributing to the magnitude of the shunt.…”