Inadvertent transvenous left ventricular pacing through an unsuspected atrial septal defect.
A 65-year-old male patient with a long standing history of chronic obstructive lung disease had permanent pacemaker implantation for symptomatic atrioventricular nodal blocks. Preoperative echocardiography showed dilated right heart chambers and moderate pulmonary arterial hypertension without any demonstrable intracardiac shunt. Postoperative twelve-lead ECG showed right bundle branch block configuration of paced complexes. This suggested left ventricular pacing which was confirmed by transthoracic echocardiography. Later, transoesophageal echocardiography showed the lead entering into left atrium from right atrium through a sinus venosus type of atrial septal defect. The patient refused any further intervention and continues to remain asymptomatic with stable pacing on aspirin-anticoagulant therapy at end of four years.
Kumar
Soumitra
S
Vivekananda Institute of Medical Sciences, Kolkata.
Ghosh
Pallav
P
Ghosh
Ajit Kumar
AK
Banerjee
Suvro
S
Banerjee
Sulagna
S
Majumder
Sudeshna
S
D000368:Aged; D016121:Brachiocephalic Veins; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D004567:Electrodes, Implanted; D005500:Follow-Up Studies; D006327:Heart Block / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications