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

HINOJOS A, ILG K. Removal of Misplaced Left Ventricular Single Lead Pacemaker in a Patient Presenting with Recurrent Transient Ischemic Attacks. Spartan Med. Res. J. Vol. 2, No. 1, pp. 64-73, 2017. CONTEXT: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.