Abnormal implantation of permanent pacemaker lead in the left ventricle via a patent foramen ovale: clinical and echocardiographic recognition of a rare complication.

An 84-year-old man with a history of permanent pacemaker placement had a preoperative cardiac evaluation for prostate cancer surgery. The patient was asymptomatic, and the results of a physical examination were consistent with a right bundle branch block, which was confirmed by electro-cardiogram as his paced rhythm. A chest radiograph raised the possibility of an abnormal lead location, and transthoracic echocardiography confirmed the mechanism of an abnormal placement of the pacemaker lead. Left ventricular location of pacemaker is rare, and awareness of its clinical and imaging findings, complications, and management options is important for clinicians involved in the care of patients with pacemakers.