Introduction
Implantation of pacemakers has increased in recent decades and has
become an important tool to treat bradycardia. With access commonly
through the left subclavian or cephalic vein, pacemaker leads are
positioned into alternative pacing sites where they can stimulate the
heart to restore normal rhythm (1). Pacemaker lead insertion through the
left subclavian artery going back to the aortic valve into the left
ventricular cavity is an extremely rare iatrogenic complication. The
frequency of this complication is unknown but believed to be largely
unreported. Common complications resulting from entry through the
subclavian artery include pneumothorax and thromboembolic events (2).
Because of these complications, immediate identification and treatment
is required before the patient leaves the electrophysiology lab, usually
by using fluoroscopy, pacemaker interrogation, or a 12-lead
electrocardiogram (ECG). If left undiagnosed, improperly placed leads
can lead to serious systemic thromboembolism. Surgical extraction of an
arterial lead can also lead to major life-threatening vascular
complication (3). We report a case of a 59-year-old man who
inadvertently had a pacemaker lead implanted via the subclavian artery.