Malposition of pacing lead into the left ventricle: a rare complication of pacemaker insertion.

To cite: Bashir A, Noroozian N, Bradlow W, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013202131 DESCRIPTION A 79-year-old woman presented with infection and erosion of a permanent pacemaker, which had been inserted 15 years earlier. A chest X-rays showed an abnormal position of ventricular lead, suggesting it was in the left rather than right ventricle (figure 1A, B). Transoesophageal echocardiography showed that it was positioned in the left ventricle due to passage through a patent foramen ovale (figure 1C). The active fix lead was inserted just beneath the mitral valve (figure 1E), a feature also appreciated on chest CT scan (figure 1D). We speculated that thromboembolic complications were not encountered as the patient had been anticoagulated for atrial fibrillation.