Extract

A 63-year-old man was referred to elective coronary catheterization for recurrent episodes of non-sustained ventricular tachycardia. He had a history of coronary artery bypass grafting surgery and implantable cardioverter defibrillator with a passive fixation right atrial lead. On coronary angiogram the graft to the right coronary artery (RCA) was totally occluded. An unusual filling mass was noticed while injecting the native RCA, which was totally occluded proximally. The mass had a pocket like appearance and very slow clearance of contrast dye. On fluoroscopy images, the right atrial lead appears to be in contact with the mass, which communicates with the RCA through a fistula (Supplementary data online, video S1). He was referred for multidetector cardiac CT (MDCT) for further evaluation. MDCT images clearly illustrate the lead tip perforating the right atrium and protruding into the anterior mass (Images 1A–D). An intraoperative transesophageal echocardiogram confirmed the findings of the MDCT (Supplementary data online, video S2 and S3). The patient then underwent surgical excision of the mass.

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