Removal of Misplaced Left Ventricular Single Lead Pacemaker in a Patient Presenting with Recurrent Transient Ischemic Attacks

Over 200,000 cardiac electronic implantable devices are annually placed in individuals living within the United States. Complications from this procedure can range up to 12%. Inadvertent lead placement into the left ventricle is a rare but recognized complication of implantable cardiac electronic devices. This is a retrospective case report of a female patient in her late 70’s who underwent atrioventricular node ablation and misplacement of single lead pacemaker, subsequently presenting with recurrent transient ischemic attacks one month later. Initial electrocardiogram and chest X-ray demonstrated misplacement of her pacemaker in the left ventricle. Medical therapy was attempted, however, patient subsequently underwent extraction via aortotomy with implantation of epicardial pacemaker. Inadvertent placement of implantable electronic cardiac devices is a rare but well recognized complication. A post-procedure electrocardiogram and chest X-ray should be routinely performed to confirm appropriate lead placement. Procedures to manage this complication are evolving with novel device therapies specifically designed for percutaneous lead extraction.