Traumatic atrial septal defect and coronary sinus to left atrium fistula from coronary sinus pacing lead removal.

CARDIAC resynchronization therapy with the placement of a left ventricular pacing electrode in the coronary sinus has been shown to be an effective treatment in selected patients with symptomatic left ventricular dysfunction. Coronary sinus leads can be removed with relative ease because of their small diameter and relatively poor fixation mechanisms. However, removal of coronary sinus electrodes could potentially rupture or perforate the coronary sinus, causing tamponade, hemodynamic instability, and death. We report a rare case of atrial septal defect (ASD) and coronary sinus to left atrium fistula without tamponade from coronary sinus lead removal.