An Unusual Cause of Transient Ischemic Attack in a Patient with Pacemaker. (4th February 2014)

• Record Type: Journal Article
• Authors: Kalavakunta, Jagadeesh Kumar; Gupta, Vishal; Paulus, Basil; Lapenna, William
• Other Names: Firschke C. Academic Editor.; Kataoka H. Academic Editor.; Mansur A. D. P. Academic Editor.; Roberts-Thomson K. Academic Editor.; Sahin T. Academic Editor.
• Is Part Of: Case reports in cardiology. Volume 2014(2014)
• Publication Date: 2014-02-04
• Subjects: Cardiology -- Periodicals; 616.12005
• DOI: 10.1155/2014/265759
• Languages: English
• ISSNs: 2090-6404

Abstract

Abstract : Pacemaker lead malposition in various locations has been described in the literature. Lead malposition in left ventricle is a rare and an underdiagnosed complication. We present a 77-year-old man with history of atrial fibrillation and pacemaker placement who was admitted for transient ischemic attack. He was on aspirin, beta blocker, and warfarin with subtherapeutic international normalized ratio. His paced electrocardiogram showed right bundle-branch block, rather than the typical pattern of left bundle-branch block, suggesting pacemaker lead malposition. Further, his chest X-ray and echocardiogram confirmed the pacemaker lead position in the left ventricle instead of right ventricle. He refused surgical removal of the lead and we increased his warfarin dose. Diagnosis of lead malposition in left ventricle, though easy to identify in echocardiogram, requires high index of clinical suspicion. In asymptomatic patients, surgical removal may be deferred for treatment with lifelong anticoagulation.