CTICasesArterial Malposition of Pacemaker Lead
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Imaging findings
CT angiography of the aorta demonstrates a pacemaker lead abnormally coursing arterially from the left subclavian artery, descending through the aortic arch and descending thoracic aorta, retrogradely crossing the aortic valve, and terminating in the lateral wall of the left ventricle.
Key takeaways
Pacemaker leads are intended to be placed in the venous system (right atrium and right ventricle). Unintentional arterial placement is a rare iatrogenic complication that can occur via inadvertent subclavian arterial puncture or transseptal passage. If left unrecognized, arterial leads pose a severe risk of thromboembolism, stroke, and valvular injury, and they often require surgical or specialized extraction.
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