title: Incidence, predictors, and outcome of inadvertent malposition of transvenous pacing or defibrillation lead in the left heart.
abstract: OBJECTIVE
  Inadvertent lead malposition (ILM) in the left heart is a potential cause of thromboembolism and, therefore, a complication of heart rhythm device implantation [HRDI: pacemaker, implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT)]. The aim of the study was to report the incidence and clinical outcome of ILM.
  
  
  RESULTS
  Postoperative lateral and posterior-anterior chest X-rays of all consecutive patients undergoing HRDI from 2007 through 2012 were retrospectively analysed. During the study period, 2579 patients underwent HRDI at our institution. ILM was present in six patients (0.34%, 50% male, mean age 71.5 ± 9.4 years). In one and four patients, malposition was in the left atrium and ventricle, respectively. In one case, the RV-lead was placed in a coronary sinus branch. In four patients, ILM was detected intra-operatively or in the early postoperative period. In the remaining two patients, malposition was not recognized and they suffered cerebral embolism 4 months and 1 year after implantation. ILM was corrected during the same hospital stay (four cases), or during follow-up by percutaneous extraction (two cases). Patients with ILM had significantly more scoliosis (16.7 vs. 0.17%; P = 0.01), congenital heart disease (CHD: 33.3 vs. 0.4%; P = 0.003), or prior surgery for CHD (16.7 vs. 0.5%; P = 0.03). The likelihood of ILM was also increased when HRDI was performed by an inexperienced operator (<100 HRDI; P < 0.01).
  
  
  CONCLUSIONS
  The incidence of ILM was 0.34% in our series. Scoliosis, CHD, prior correction of CHD, and limited operator experience were identified as risk factors.
authors.affiliation: Department of Cardiology, Zentralklinik, Robert-Koch-Allee 9, Bad Berka 99437, Germany marc.ohlow@zentralklinik.de.
authors.forename: Marc-Alexander
authors.initials: MA
authors.lastname: Ohlow
authors.affiliation: Clinic for Electrophysiology, Heart Center, Salzburger Leite 1, Bad Neustadt 67616, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Roos
authors.affiliation: Department of Cardiology, Zentralklinik, Robert-Koch-Allee 9, Bad Berka 99437, Germany.
authors.forename: Bernward
authors.initials: B
authors.lastname: Lauer
authors.affiliation: Medizinische Klinik I, Krankenhaus Hetzelstift, Neustadt/Weinstrasse, Germany.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Von Korn
authors.affiliation: Department of Invasive Electrophysiology, Zentralklinik, Robert-Koch-Allee 9, Bad Berka 99437, Germany.
authors.forename: Johann Christoph
authors.initials: JC
authors.lastname: Geller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D005858:Germany; D006331:Heart Diseases / Q000151:congenital / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy; D011361:Professional Competence; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Complication; Congenital heart disease; Implantable defibrillator; Lead malposition; Operator experience; Pacemaker