Pacemaker lead malpositioning led to subsequent ischemic strokes despite antiplatelet and anticoagulation therapy.

Pacemaker lead malpositioning may lead to severe clinical adverse events. Rarely, cases of inadvertent placement of a lead into the left ventricle are reported in the literature. We herein report a case of pacemaker lead malpositioning into the left ventricle via a persistent foramen ovale in a male caucasian patient.

Pacemaker lead malposition in the left atrial roof is masked by normal pacing thresholds.

Pacemaker lead malpositioning with subsequent cardiac tamponade is a rare, but serious adverse event. We herein report a case of pacemaker lead malpositioning in a 76-year old female caucasian patient. The lead was malpositioned into the roof of the left atrium after perforation of the superior vena cava, resulting in cardiac tamponade.