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An Unusual Appearance of a Pacemaker Lead
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An Unusual Appearance of a Pacemaker Lead Julia Osipova, Christian Templin, Firat Duru, Thomas F. Lüscher and Jelena R. Ghadri, MD ∗ Cardiology, Cardiovascular Center, University Hospital, Zurich, Zurich, Switzerland
A
n 85 year-old female underwent two-chamberpacemaker (ADDR) implantation for symptomatic third degree atrioventricular block. Chest radiography before discharge demonstrated infradiaphragmatic localisation of the pacemaker wire (arrowhead, Panel A and B), hence myocardial perforation was highly suspected. Further urgent evaluation by chest computed tomography (CT) was recommended by our radiologists, despite the lack of patient’s symptoms compatible with a diaphragm perforation. Pacemaker ventricular pacing parameters were normal (arrowhead, Panel C). Chest CT confirmed
a correct lead placement in the right atrium (arrowhead, Panel D) and apex (arrowhead, Panel E–G) without evidence for diaphragm perforation. Myocardial perforation is a serious but very rare complication of pacemaker lead insertion. Our X-ray images demonstrate an unusual appearance of the ventricular lead despite correct location at the right ventricular apex (Fig. 1).
Conflict of Interest None.
Figure 1. A and B, chest radiography in p.a. and lateral projections indicating infradiaphragmatic localisation of pacemaker wire. C, pacemaker ventricular pacing is normal. D–G, CT-chest discloses a correct lead placement without any evidence for right ventricular perforation (black arrows E–G).
Received 4 December 2012; received in revised form 1 January 2013; accepted 2 January 2013; available online 4 February 2013 ∗
Corresponding author at: Department of Cardiology, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. Tel.: +41 44 255 95 85; fax: +41 44 255 44 01. E-mail address: [email protected] (J.R. Ghadri).
© 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2013.01.002
Image
An Unusual Appearance of a Pacemaker Lead Julia Osipova, Christian Templin, Firat Duru, Thomas F. Lüscher and Jelena R. Ghadri, MD ∗ Cardiology, Cardiovascular Center, University Hospital, Zurich, Zurich, Switzerland
A
n 85 year-old female underwent two-chamberpacemaker (ADDR) implantation for symptomatic third degree atrioventricular block. Chest radiography before discharge demonstrated infradiaphragmatic localisation of the pacemaker wire (arrowhead, Panel A and B), hence myocardial perforation was highly suspected. Further urgent evaluation by chest computed tomography (CT) was recommended by our radiologists, despite the lack of patient’s symptoms compatible with a diaphragm perforation. Pacemaker ventricular pacing parameters were normal (arrowhead, Panel C). Chest CT confirmed
a correct lead placement in the right atrium (arrowhead, Panel D) and apex (arrowhead, Panel E–G) without evidence for diaphragm perforation. Myocardial perforation is a serious but very rare complication of pacemaker lead insertion. Our X-ray images demonstrate an unusual appearance of the ventricular lead despite correct location at the right ventricular apex (Fig. 1).
Conflict of Interest None.
Figure 1. A and B, chest radiography in p.a. and lateral projections indicating infradiaphragmatic localisation of pacemaker wire. C, pacemaker ventricular pacing is normal. D–G, CT-chest discloses a correct lead placement without any evidence for right ventricular perforation (black arrows E–G).
Received 4 December 2012; received in revised form 1 January 2013; accepted 2 January 2013; available online 4 February 2013 ∗
Corresponding author at: Department of Cardiology, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland. Tel.: +41 44 255 95 85; fax: +41 44 255 44 01. E-mail address: [email protected] (J.R. Ghadri).
© 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2013.01.002