[Misplacement of a transvenous lead from an implantable cardioverter-defibrillator into the left ventricle via a patent foramen ovale].
METHODS
24-hour ECG monitoring in a 64-year-old man revealed self-limited (< 30 s) ventricular tachycardias (VT) of > 200/min. He had triple-vessel coronary artery disease with both anterior and posterior wall infarctions treated by three aortocoronary venous grafts. Physical examination was unremarkable except for a well healed thoracotomy scar.


METHODS
Programmed ventricular stimulation induced prolonged monomorphic VT of 320 beats/min, despite aminodarone treatment. Left-heart catheterization demonstrated the three patent aortocoronary grafts and a left-ventricular ejection fraction of only 20%.


METHODS
Because of the inducible and prolonged VT, despite antiarrhythmic treatment with amiodarone, a cardioverter-defibrillator was implanted (ICD). During threshold measurements of the pacemaker integrated into the ICD the pacemaker impulse was noted to produce a right bundle branch block pattern, the ICD lead having erroneously been placed in the left ventricle via a patent foramen ovale. The lead was left in place, because the ICD was functioning well and lead removal with the possible need of a thoracotomy carried a high risk.


CONCLUSIONS
Extreme caution is needed to avoid malpositioning an implantable cardioverter-defibrillator. If the lead tip is unwittingly fixed in the left ventricle but functions well it should be left in place under prophylactic anticoagulation, because of the potentially high risk of its operative removal.
Wieckhorst
A
A
Abteilung für Kardiologie und Pulmologie, Universitätsklinikum Göttingen.
Herse
B
B
Unterberg
C
C
D000638:Amiodarone / Q000627:therapeutic use; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004452:Echocardiography; D004562:Electrocardiography; D006339:Heart Rate; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000628:therapy*
D000638:Amiodarone