An Unusual Appearance of a Pacemaker Lead

A 85 year-old female underwent two-chamberpacemaker (ADDR) implantation for symptomatic third degree atrioventricular block. Chest radiography before discharge demonstrated infradiaphragmatic localisation of the pacemaker wire (arrowhead, Panel A and B), hence myocardial perforation was highly suspected. Further urgent evaluation by chest computed tomography (CT) was recommended by our radiologists, despite the lack of patient’s symptoms compatible with a diaphragm perforation. Pacemaker ventricular pacing parameters were normal (arrowhead, Panel C). Chest CT confirmed a correct lead placement in the right atrium (arrowhead, Panel D) and apex (arrowhead, Panel E–G) without evidence for diaphragm perforation. Myocardial perforation is a serious but very rare complication of pacemaker lead insertion. Our X-ray images demonstrate an unusual appearance of the ventricular lead despite correct location at the right ventricular apex (Fig. 1).