Figure 10. Lateral chest X-ray with representation of chamber anatomy.6 The ventricular lead (b) and atrial lead (a) are both seen projecting anteriorly.
Management of a misplaced LV lead depends on symptoms and risks of intervention. Lead removal presents a risk of thromboembolic events, and so surgical removal is usually withheld from asymptomatic patients or patients in poor health. Anticoagulation therapy is currently the most popular method of treatment. However, if anticoagulation therapy is ineffective and thromboembolic complications occur, surgical intervention must be considered.7 In our case, surgical extraction was needed due to infected pacemaker pocket and because of the mitral regurgitation that was caused by the misplaced ventricular lead.