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Case Reports in Cardiology
Volume 2014, Article ID 265759, 3 pages
http://dx.doi.org/10.1155/2014/265759
Case Report

An Unusual Cause of Transient Ischemic Attack in a Patient with Pacemaker

1Division of Cardiology, Michigan State University, 804 Service Road, A205 Clinical Center, East Lansing, MI, 48824, USA
2Division of Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, USA

Received 3 December 2013; Accepted 24 December 2013; Published 4 February 2014

Academic Editors: C. Firschke, H. Kataoka, A. D. P. Mansur, K. Roberts-Thomson, and T. Sahin

Copyright © 2014 Jagadeesh Kumar Kalavakunta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pacemaker lead malposition in various locations has been described in the literature. Lead malposition in left ventricle is a rare and an underdiagnosed complication. We present a 77-year-old man with history of atrial fibrillation and pacemaker placement who was admitted for transient ischemic attack. He was on aspirin, beta blocker, and warfarin with subtherapeutic international normalized ratio. His paced electrocardiogram showed right bundle-branch block, rather than the typical pattern of left bundle-branch block, suggesting pacemaker lead malposition. Further, his chest X-ray and echocardiogram confirmed the pacemaker lead position in the left ventricle instead of right ventricle. He refused surgical removal of the lead and we increased his warfarin dose. Diagnosis of lead malposition in left ventricle, though easy to identify in echocardiogram, requires high index of clinical suspicion. In asymptomatic patients, surgical removal may be deferred for treatment with lifelong anticoagulation.