An Unusual Cause of Transient Ischemic Attack in a Patient with Pacemaker
Open Access
- 4 February 2014
- journal article
- case report
- Published by Hindawi Limited in Case Reports in Cardiology
- Vol. 2014 (6), 1-3
- https://doi.org/10.1155/2014/265759
Abstract
Pacemaker lead malposition in various locations has been described in the literature. Lead malposition in left ventricle is a rare and an underdiagnosed complication. We present a 77-year-old man with history of atrial fibrillation and pacemaker placement who was admitted for transient ischemic attack. He was on aspirin, beta blocker, and warfarin with subtherapeutic international normalized ratio. His paced electrocardiogram showed right bundle-branch block, rather than the typical pattern of left bundle-branch block, suggesting pacemaker lead malposition. Further, his chest X-ray and echocardiogram confirmed the pacemaker lead position in the left ventricle instead of right ventricle. He refused surgical removal of the lead and we increased his warfarin dose. Diagnosis of lead malposition in left ventricle, though easy to identify in echocardiogram, requires high index of clinical suspicion. In asymptomatic patients, surgical removal may be deferred for treatment with lifelong anticoagulation.Keywords
This publication has 10 references indexed in Scilit:
- Inadvertent malposition of a permanent pacemaker ventricular lead into the left ventricle which was initially missed and diagnosed two years later: a case reportJournal of Medical Case Reports, 2011
- Malpositioning of a pacemaker lead to the left ventricle accompanied by posterior mitral leaflet injuryInteractive CardioVascular and Thoracic Surgery, 2008
- Iatrogenic Perforation of the Posterior Mitral Valve Leaflet: A Rare Complication of Pacemaker Lead PlacementJournal of the American Society of Echocardiography, 2008
- Eight years of left ventricle pacing due to inadvertent malposition of a transvenous pacemaker lead in the left ventricleEuropean Heart Journal – Cardiovascular Imaging, 2008
- An Electrocardiographic Algorithm for Determining the Location of Pacemaker Electrode in Patients With Right Bundle Branch Block Configuration During Permanent Ventricular PacingAngiology, 2006
- Management of Inadvertent Left Ventricular Permanent PacingJournal of Interventional Cardiac Electrophysiology, 2004
- Diagnosis and Management of Inadvertently Placed Pacing and ICD Leads in the Left Ventricle: A Multicenter Experience and Review of the LiteraturePacing and Clinical Electrophysiology, 2000
- Left Heart Pacing and Cardioembolic StrokePacing and Clinical Electrophysiology, 1994
- Asymptomatic Left Ventricular Malposition of a Transvenous Pacemaker Lead Through a Sinus Venosus Defect: Follow-up Over 17 YearsPacing and Clinical Electrophysiology, 1991
- Perforation of the Right Ventricle by Electrode CathetersAnnals of Surgery, 1968