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Inadvertent pacing lead placement in the left ventricle (LV) is an uncommon complication of cardiac pacing therapy, first reported by Stillman and Richards in 1969.1 This can occur when the lead was passed through an atrial-septal defect, a patent foramen ovale (PFO),2,3 via perforation of the intraventricular septum1 or subclavian arterial insertion.4 It is associated with increased risk of thromboembolic events and increased morbidity and mortality.5,6 It can be detected by various cardiac imaging modalities including echocardiography or cardiac computed tomography (CT).5 However, incidental detection of pacing lead in the LV by low-resolution CT with myocardial perfusion imaging (MPI) has not been reported previously. Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a well-established technique for evaluation of coronary artery disease (CAD).7 To improve image quality, low-resolution CTs commonly are used for anatomical correction and artifact attenuation during SPECT MPI.8 The low-resolution, unenhanced CT images are considered low-quality, therefore, labelled by manufacturers as “non-diagnostic”. The CT portion of the MPI at many centers is used only for image fusion and attenuation correction, and their images are not reviewed or reported routinely by cardiologists.8 This report describes a case of incidental detection of inadvertent placement of pacing lead in the LV by low resolution CT used during cardiac MPI. This case suggested that it is appropriate and necessary to review low-resolution CT images during cardiac MPI for incidental findings of clinically significance.

Incidental Detection of Inadvertent Pacing Lead Placement in the Left Ventricle by Myocardial Perfusion Imaging Study