Zaher Medhat F, Azab Basem N, Bogin Marc B, Bekheit Soad G
Cardiology Department, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
J Med Case Rep. 2011 Feb 9;5:54. doi: 10.1186/1752-1947-5-54.
Inadvertent malposition of a pacemaker ventricular lead into the left ventricle is an uncommon event, and its actual incidence is probably unknown. It may be underestimated and underreported because of a possible asymptomatic course. A 12-lead electrocardiogram is important to confirm proper placement.
We report a case of a 60-year-old Caucasian man with a malpositioned transvenous permanent pacing lead into the left ventricle via a patent foramen ovale that was not suspected during implantation and went undiagnosed for two years without complications. The patient remained asymptomatic as he was being treated with oral anticoagulation therapy for atrial fibrillation. The decision was made to leave the pacing lead in place and continue lifelong warfarin therapy.
Inadvertent insertion of pacing wires into the left ventricle is a potentially dangerous complication that may happen under fluoroscopic guidance and may be overlooked by routine pacemaker interrogation. It is advisable to obtain a 12-lead electrocardiogram during or immediately after transvenous pacemaker implantation rather than use a routine pacemaker interrogation or a limited electrocardiogram.
起搏器心室导线意外误置于左心室是一种罕见事件，其实际发生率可能未知。由于可能无症状，其发生率可能被低估且报告不足。12导联心电图对于确认正确放置很重要。
我们报告一例60岁白种男性病例，其经静脉植入的永久性起搏导线通过卵圆孔未闭误置于左心室，植入时未被怀疑，且两年未被诊断出，无并发症。该患者因房颤接受口服抗凝治疗，一直无症状。决定保留起搏导线并继续终身华法林治疗。
起搏导线意外插入左心室是一种潜在危险的并发症，可能在透视引导下发生，且可能被常规起搏器问询忽视。建议在经静脉起搏器植入期间或植入后立即进行12导联心电图检查，而非使用常规起搏器问询或有限的心电图检查。
