title: Entrapment of pacemaker lead by a large net-like Eustachian valve within the right atrium.
abstract: During pacemaker implantation in a patient with permanent atrial fibrillation, it remained impossible to advance a passive fixation lead with fins through the right atrium. However, a lead with a retractable screw easily passed the right atrium and was positioned in the right ventricle. Transesophageal echocardiography revealed an extensive net-like perforated Eustachian valve within the right atrium that had caused entrapment of the anchor fins during lead implantation. Remnants of embryonal structures within the right atrium should be considered a rare possible barrier during pacemaker implantation.
authors.affiliation: Abteilung Kardiologie, Klinikum Bremerhaven Reinkenheide, Medizinische Klinik I, Postbrookstrasse 103, 27574 Bremerhaven, Germany. ruediger.dissmann@zkr.de
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Dissmann
authors.forename: Joachim
authors.initials: J
authors.lastname: Schröder
authors.forename: Heinz
authors.initials: H
authors.lastname: Völler
authors.forename: Steffen
authors.initials: S
authors.lastname: Behrens
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy; D017548:Echocardiography, Transesophageal; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D014261:Tricuspid Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging