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.