Presentation
Shortness of breath.
Patient Data
A biventricular pacemaker is present. The left ventricular lead is fractured and discontinuous with a 2 mm separation near the generator pack in the left chest wall. The right atrial and right ventricular leads are continuous and the lead tips project over the appropriate locations.
Mild cardiomegaly. The lungs are clear. No pleural effusion.
Case Discussion
Biventricular cardiac pacemakers are placed when the right and left ventricles beat dyssynchronously i.e. not at the same time. A dyssynchronous rhythm is very inefficient: the left and right ventricles are essentially tugging the septum back and forth. A biventricular pacemaker is placed to restore a synchronous rhythm. There are 3 leads: one in the right atrium, one in the right ventricle and a left ventricular lead in a vein draining the left ventricle placed through the coronary sinus. In this case, the pacemaker was not functioning properly because the left ventricular lead had fractured.
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