Transvenous pacemaker malposition in the systemic circulation and pacemaker infection: a case report and review of the literature.

Transvenous pacemaker malposition in the systemic circulation is a rare complication of pacemaker implantation; the incidence is not well known. However, with the aid of two-dimensional echocardiography, the problem of pacemaker malposition can be identified earlier. After pacemaker insertion, an electrocardiogram and a posterior-anterior and lateral chest x-ray should be routinely performed. In difficult cases, transthoracic echocardiography and transesophageal echocardiography can be helpful for better visualization and confirmation of the malposition of the pacemaker lead(s). Pacemaker infection is another complication. A case of pacer lead malposition into the left ventricle through a sinus venosus atrial septal defect and superimposed infection is reported, and the management of endocardial lead malposition in the systemic circulation and pacemaker infection is reviewed.