PMC10008109_01
(a) Right thoracic anatomy and (b) anteroposterior chest X-ray.
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fig1
DF1, Medtronic, Minneapolis, MN, USA) on the right side connected to a ventricular lead (Saint Jude Medical Durata) with active fixation to the interventricular septum. During follow up, the can glided into the axillary fossa, prompting multiple interventions until a pocket was eventually created by a Plastic Surgeon in the right mammary region (Figure 1).
ECG at admission.
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Coronary angiography in the 30  left anterior oblique (a) and 20  right anterior oblique (b) views, showing compression of the LAD. Of note, in the right anterior oblique view, the implantation site is distal to the heart silhouette, suggesting a very anterior position.
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fig3
As some evolution was suspected concerning her coronary disease, a coronary artery angiography was performed (Figure 3), showing lack of new stenosis, but a compression of the distal LAD coronary artery at the implantation site of the RV lead.
Anteroposterior fluoroscopic view showing the final placement of the leads and of the can.
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fig4
The following day chest X-ray (Figure 4) showed no lead displacement and the ECG revealed satisfactory resynchronization pattern (Figure 5).
ECG after resynchronization.
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fig5
The following day chest X-ray (Figure 4) showed no lead displacement and the ECG revealed satisfactory resynchronization pattern (Figure 5).