title: Inadvertent transarterial pacemaker lead placement.
abstract: We present a case of a 73-year-old patient with acute left-sided hemiparesis four months after right ventricular pacemaker insertion. Post-procedural electrocardiogram revealed a paced RBBB complex and an abnormal lead path on chest X-ray. Subsequent echocardiography and computed tomography showed left ventricular pacemaker malposition with retrograde passage to the punctured subclavian artery. We also discuss the utility of routine cardiac investigations post-insertion to identify signal lead malposition as well as management strategies once identified.
authors.affiliation: Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Canada; Schulich Heart Center, Sunnybrook Health Sciences Center, Toronto, Canada. Electronic address: ravi.bajaj@mail.utoronto.ca.
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Bajaj
authors.affiliation: Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Fam
authors.affiliation: Schulich Heart Center, Sunnybrook Health Sciences Center, Toronto, Canada.
authors.forename: Sheldon M
authors.initials: SM
authors.lastname: Singh
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography; D004562:Electrocardiography; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications; D013902:Radiography, Thoracic; D056346:Sternotomy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
keywords: Artificial; Bundle-branch block; Pacemaker; Post-operative complications; Stroke