case_images: PMC11338797_01
case_images: (A) Electrocardiogram (ECG) post temporary pacing. ECG showed P wave was not associated with QRS complex, indicated AV blocked. The axis of pacing QRS showed significant left deviation (-87o). The QRS pattern of V1 with a positive deflection and S wave in final part of V5-V6, showed the tip of temporary lead in the free wall of left ventricle. (B) Image showed the tip of the temporary lead located in the left ventricle with crossing the interventricular septum (arrow) in apical 4-chamber view. (C,D) The lead tip close to the left posterior free wall (arrow) was confirmed by lung CT and chest x-ray.
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case_images: PMC11338797_01_fcvm-11-1429480-g001.jpg
case_images: F1
case_images: An electrocardiogram (ECG) showed a sinus rhythm (Figure 1A), third-degree atrio-ventricular block and left ventricular pacing pattern with complete right bundle branch block (RBBB). In the echocardiogram, we found the tip of the temporary pacemaker led to be located in the left ventricle with its lead crossing the interventricular septum and a small amount of circumferential pericardial effusion with no obvious perforation (Figure 1B). This misplacement was confirmed by lung CT and chest x-ray, showed the lead tip close to the left posterior free wall (Figures 1C,D).
case_images: (A) ECG post permanent pacemaker implantation. The ECG suggested deep septal pacing with the tip of the lead close to the left posterior branch. (B) Craniocerebral CT- scan showed an infarction in his right cerebellum (arrow). (C) Anteroposterior chest radiograph of dual-chamber pacemaker implantation.
case_images: fcvm-11-1429480-g002.jpg
case_images: PMC11338797_01_fcvm-11-1429480-g002.jpg
case_images: F2
case_images: Next day, the placement of a dual-chamber pacemaker (Figure 2C) was carried out as planned, using the Select Secure pacing lead (Model 3830 69 cm, Medtronic Inc., Minneapolis, MN, USA) for left bundle branch area pacing. ECG indicated left bundle branch pacing with incomplete RBBB pattern (Figure 2A). Upon this, a craniocerebral CT-scan was performed, showing an infarction in his right cerebellum (Figure 2B).