Automatic Internal Cardiac Defibrillator Lead in the Left Ventricle

Introduction: Inadvertent insertion of a pacemaker/defibrillator lead into the left ventricle is an uncommon event, and its actual incidence is probably unknown. It may be underestimated and underreported because of a possible asymptomatic course.Case presentation: We report a case of a 63-year-old Caucasian man with a malpositioned ICD lead into the left ventricle via a subclavian artery that was not suspected during implantation and went undiagnosed for 3 months without complications. The patient remained asymptomatic. He underwent an uncomplicated removal of the device and subsequent placement of a new ICD in the right ventricle.Conclusions: Inadvertent insertion of a pacemaker/defibrillator lead into the left ventricle is a potentially dangerous complication that may occur under fluoroscopic guidance and may be overlooked by routine device interrogation. Careful attention to lead position on CXR posteroanterior and lateral views as well as 12-lead ECG in ventricular paced (magnet mode) after device implantation is recommended