Imaging in cardiology

Address for correspondence: G.S. de Ruiter E-mail: gijsenbwee@freeler.nI suffered from multiple episodes ofatrial fibrillation for which treatment by means ofelectric counter shock had to be administered several times. On presentation, shortly after initiation ofverapamil (80mg twice a day), the electrocardiogram showed an AV-junctional rhythm of4O bpm. Verapamil was discontinued. Due to the alternating episodes of supraventricular tachycardia and bradycardia, DDD-r pacemaker implantation was indicated. The implant procedure was carried out by an approach from the left subclavian vein. A persistent left superior caval vein was encountered (figure 1). A screw-in atrial electrode was introduced via the persistent left superior caval vein through the dilated coronary sinus into the right atrium. Traumatic fixation