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Case Reports
. 2013 Jul 5:6:29-32.
doi: 10.2147/IMCRJ.S45784. Print 2013.

Sinus venosus atrial septal defect: a rare cause of misplacement of pacemaker leads

Malick Bodian  1 , Fatou Aw, Mouhamadou Ndiaye Bamba, Adama Kane, Modou Jobe, Alioune Tabane, Alassane Mbaye, Simon Antoine Sarr, Maboury Diao, Moustapha Sarr, Serigne Abdou Bâ
Affiliations
Case Reports

Sinus venosus atrial septal defect: a rare cause of misplacement of pacemaker leads

Malick Bodian et al. Int Med Case Rep J. .

Abstract

Routine implantation of pacemakers and implantable cardioverter defibrillators is not commonly associated with complications. However, in some cases we see misplacement of pacemaker leads which is most often related to the presence of underlying cardiac anomalies. We report the case of misplacement of a pacemaker lead into the left ventricle of a 56-year-old patient paced in VVI/R mode and with a tined type pacemaker lead because of a symptomatic complete atrioventricular block. Electrocardiogram showed a pacemaker-generated rhythm with a right bundle branch block pattern. Chest X-ray showed the pacemaker lead located relatively high in relation to the diaphragm. Echocardiography visualized the pacemaker lead in the left heart chambers (atrium and ventricle), hence confirming its aberrant course. Further, the defect causing its passage to the left heart chambers was a sinus venosus atrial septal defect. The patient reported no complication related to the misplacement of the lead. After a brief period of oral anticoagulation, the lead was inserted into the right ventricle by percutaneous technique.

Keywords: lead misplacement; pacemaker; sinus venosus atrial septal defect.

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Figures

Figure 1
Figure 1
(A) Post-implantation electrocardiogram showing ventricular spikes and a right bundle branch block pattern. (B) Post-implantation chest X-ray showing the pacemaker lead (arrow) located relatively high in relation to the diaphragm.
Figure 2
Figure 2
(A and B) Two-dimensional transthoracic echocardiography with a parasternal long axis view showing pacemaker lead (arrow) in the left heart chambers. Abbreviations: LA, left atrium; LV, left ventricle; RV, right ventricle.
Figure 3
Figure 3
(A and B) Two-dimensional echocardiographic subcostal view showing the sinus venosus atrial septal defect (defect in the superior-posterior portion of the interatrial septum at the junction of the superior vena cava and right atrium). Abbreviations: ASD, atrial septal defect; LA, left atrium; RA, right atrium.
Figure 4
Figure 4
Post reimplantation electrocardiogram showing a left bundle branch block pattern, indicating the presence of the lead in the right cavities.
See this image and copyright information in PMC

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