Inadvertent Temporary Pacemaker Lead Placement in Aortic Sinus
A 50-year-old female was referred to our emergency with history of recurrent syncope followed by cardiac arrest for which she underwent temporary pacemaker insertion at a peripheral primary care center. The pacemaker was inserted through right femoral access without fluoroscopic guidance. After haemodynamic stabilization she was referred to our tertiary care center for further management. On examination, pulse rate was 60/min and regular. Blood pressure was 130/70 mm Hg. Cardiovascular system examination was unremarkable. Electrocardiogram showed paced rhythm mimicking atrial pacing with short PR interval followed by narrow QRS complexes []. The QRS axis was normal (+45°). Echocardiography showed looped pacing lead in the ascending aorta. There was no pericardial effusion.\nFluoroscopy showed temporary pacing lead, which traversed through the aorta and forming abnormal loops within ascending aorta with the tip facing downwards and engaged in the non-coronary sinus [Figure and ; Videos and ]. Vascular access sheath guide wire was also seen within the right atrium extending into superior venacava and inferior venacava. The pacing threshold was 5 Volts and she was pacemaker dependent.\nThe patient underwent successful percutaneous retrieval of the guide wire using gooseneck snare [Figure and , Videos and ] followed by placement of trans- venous temporary pacemaker lead inside RV. Later the pacemaker lead inside ascending aorta was removed. Finally she underwent permanent pacemaker implantation through right subclavian vein access.