Eight years of left ventricle pacing due to inadvertent malposition of a transvenous pacemaker lead in the left ventricle

The inadvertent malposition of a pacemaker lead in the left ventricle is a rare and underdiagnosed pacemaker complication. A 78-year-old woman was admitted to our Emergency Department for progressive dyspnea, 8 years after transvenous pacemaker implantation. Routine 12-lead electrocardiography revealed a right bundle branch block on the paced beats, and lateral chest X-ray showed posterior deflection of the pacemaker lead, suggesting a pacemaker electrode in the left ventricle. Echocardiography confirmed that the pacing lead had migrated through the foramen ovale into the left ventricle. After review of the literature and taking into account the age and emboligenic-free history of the patient under platelet therapy, we decided to postpone the surgical removal of the malpositioned lead in the left ventricle until the need arose for cardiac surgery for additional reasons, such as valve and/or coronary illness. The general therapeutic strategy remained unchanged due to the risk of bleeding complications with anticoagulation in the patient. This case illustrates the prominent role of echocardiography in the diagnosis of unusual cardiac events