https://orcid.org/0000-0002-9160-930X
A 76-year-old man, with a previous history of single-chamber pacemaker implantation 16 days before, attended the emergency department with dyspnoea and general discomfort. A posteroanterior and lateral chest X-ray was performed, suggesting the malposition of the right ventricle lead (Panel A). The device was interrogated, exhibiting a paced QRS with the right bundle branch block morphology (Panel B) and high capture threshold (3.25 V × 1 ms). A bedside transthoracic echocardiography was performed, showing severe pericardial effusion with incipient signs of cardiac tamponade and lead placement in the coronary sinus and inferolateral wall of the left ventricle, with its tip in the pericardial space (Panels C and D, arrows;Supplementary material online, Video S1).
The study was completed with computed tomography (CT), which established the diagnosis. Three-dimensional (3D) reconstruction of the lead course confirmed its entry into the coronary sinus with perforation of a posterolateral branch (Panel E), which provided invaluable information for surgical planning. The absence of left ventricular perforation allowed for off-pump surgery without sternotomy to remove and reposition the lead.
To the best of our knowledge, the use of 3D reconstruction by CT in pacemaker lead malposition for surgical planning has not been previously reported. CT is a powerful and accurate tool in diagnosing lead perforation and locating intracardiac leads when other modalities are not diagnostic.
Supplementary data are available at European Heart Journal – Cardiovascular Imaging online.
Conflict of interest: None declared.
Funding: None declared.
Data availability Data available on request from the authors.
