title: Chest pain associated with moderator band pacing.
abstract: A 65-year-old man was evaluated for chronic chest pain that had been present for 8 years after placement of a dual-chamber implantable cardioverter-defibrillator to treat inducible ventricular tachycardia. Previous coronary angiography had revealed nonobstructive coronary artery disease and a left ventricular ejection fraction of 0.45 to 0.50, consistent with mild idiopathic nonischemic cardiomyopathy. Evaluation with chest radiography and transthoracic echocardiography showed the implantable cardioverter-defibrillator lead to be embedded within the right ventricle at the moderator band, which had mild calcification. Treatment included extraction of the dual-coil lead and placement of a new single-coil right ventricular lead at the mid septum. The patient had complete relief of symptoms after the procedure. This case shows that chest pain can be associated with the placement of a right ventricular implantable cardioverter-defibrillator lead in the moderator band and that symptomatic relief can occur after percutaneous lead extraction and the implantation of a new right ventricular lead to the mid septal region.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Goli
authors.forename: Karoly
authors.initials: K
authors.lastname: Kaszala
authors.forename: Mohammed N
authors.initials: MN
authors.lastname: Osman
authors.forename: John
authors.initials: J
authors.lastname: Lucke
authors.forename: Roger
authors.initials: R
authors.lastname: Carrillo
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D002637:Chest Pain / Q000209:etiology* / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D006801:Humans; D008297:Male; D017180:Tachycardia, Ventricular / Q000628:therapy*
keywords: Electrodes, implanted; heart conduction system; moderator band, right ventricular; pacemaker lead extraction; pacemaker, artificial/adverse effects; percutaneous intervention