PMC3707482_01
(A) Post-implantation electrocardiogram showing ventricular spikes and a right bundle branch block pattern. (B) Post-implantation chest X-ray showing the pacemaker lead (arrow) located relatively high in relation to the diaphragm.
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Post-implantation electrocardiography showed a pacemaker-generated rhythm with ventricular spikes and a right bundle branch pattern (Figure 1A), and chest X-ray showed the pacemaker lead located relatively high in relation to the diaphragm (Figure 1B).
(A and B) Two-dimensional transthoracic echocardiography with a parasternal long axis view showing pacemaker lead (arrow) in the left heart chambers.. Abbreviations: LA, left atrium; LV, left ventricle; RV, right ventricle.
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These findings lead us to consider possible misplacement of the lead which was confirmed by transthoracic echocardiography visualizing the pacemaker lead in the left atrium and ventricle and its attachment to the posterior wall of the left ventricle (Figure 2A and B).
(A and B) Two-dimensional echocardiographic subcostal view showing the sinus venosus atrial septal defect (defect in the superior-posterior portion of the interatrial septum at the junction of the superior vena cava and right atrium).. Abbreviations: ASD, atrial septal defect; LA, left atrium; RA, right atrium.
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We noted the presence of a sinus venosus atrial septal defect (Figure 3A and B).
Post reimplantation electrocardiogram showing a left bundle branch block pattern, indicating the presence of the lead in the right cavities.
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This was confirmed by electrocardiogram (appearance of a left bundle branch block pattern, Figure 4) and by Doppler echocardiography.