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doi:10.1093/europace/eux048
IMAGES IN ELECTROPHYSIOLOGY Online publish-ahead-of-print 10 April 2017
.....................................................................................................................................................
Right ventricular lead malposition
Justin Z. Lee*, David Wasserman, Siva K. Mulpuru
Pacing and Cardiac Electrophysiology, Department of Cardiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, 85054 Arizona, USA
* Corresponding author. Tel: 1-480-301-4072. E-mail address: lee.justin1@mayo.edu

A 67-year-old man with history of non-ischemic dilated

cardiomyopathy and ventricular fibrillation followed by
placement of dual-chamber implantable cardioverter-de-
fibrillator underwent cardiac resynchronization therapy
upgrade due to left bundle branch block and persistence
of low-left ventricular ejection fraction despite optimal
medical therapy. Chest X-ray (Panel A) revealed a poster-
iorly coursed right ventricular (RV) lead. Intra-procedure
fluoroscopy and angiography (Panel B) revealed that RV
lead was placed in the middle cardiac vein. Malpositioning
of the RV lead may be avoided by advancing the lead into
the pulmonary artery and then dropping it down into the
right ventricular apex.

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