Case report: inadvertent misplacement of pacemaker leads in the left ventricle and left circumflex artery.

Background: Pacemaker implantation has become a routine procedure in contemporary cardiology. Several possible complications during and after the procedure have been described, with this article focusing on the rare complication and the prevention of left-sided lead placement after arterial puncture.

Case summary: A 90-year-old female patient was admitted to our hospital due to recurrent transient ischaemic attacks following a dual-chamber pacemaker implantation six weeks earlier. Echocardiography and fluoroscopy revealed misplacement of the pacemaker leads in the left ventricle and left circumflex artery. After Heart Team discussion, a leadless pacemaker was implanted and the leads were extracted without complications. A coronary lesion caused by the pacemaker lead was treated by implantation of a drug-eluting stent, and the patient was discharged 5 days later.

Discussion: There is limited evidence on the management of pacemaker leads being actively fixed in the coronary system and left ventricle. In this case we were able to demonstrate that even in elderly patients the removal of recently implanted leads may be seen as a therapeutic option.