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(Circulation. 2005;112:e67.)
© 2005 American Heart Association, Inc.

Images in Cardiovascular Medicine

Dense Right-Sided Hemiparesis in a 36-Year-Old Woman

Anne B. Curtis, MD; Edward Gesier, MD; Raymond G. Cutro, MD

From University of Florida Division of Cardiovascular Medicine, Gainesville, Fla.

Correspondence to Raymond Cutro, MD, University of Florida Division of Cardiovascular Medicine, 1600 SE Archer Rd, POB 100277, Gainesville, FL 32610. E-mail jolicmd{at}medicine.ufl.edu

Six months after implantation of a dual-chamber pacemaker at an outside facility for sinus bradycardia, a 38-year-old woman had a cerebrovascular accident that resulted in aphasia and dense right-sided hemiparesis. A transthoracic echocardiogram demonstrated a patent foramen ovale, and she was referred for further evaluation. On review of the echocardiogram, it was determined that the atrial lead traversed the patent foramen and the tip was in the mid-left atrium. After >6 weeks of adequate anticoagulation, the lead was removed, and a new atrial lead was placed in the right atrial appendage.

The posteroanterior (PA) and lateral chest x-rays on the left (Figure 1) show the original position of the atrial lead in the left atrium. The PA and lateral chest x-rays on the right (Figure 2) show the new atrial lead in the right atrium. What is notable is that the PA views do not look very different, which would make it difficult to recognize that the original lead was positioned in the left atrium. However, the lateral film clearly shows the atrial lead coursing posteriorly and thus in the left atrium, compared with the lateral film after replacement of the lead, which shows the correct anterior position of the right atrial lead. Lateral chest x-ray films are important after placement of permanent pacing leads to assure proper lead position.

View larger version (92K): [in this window] [in a new window]   Figure 1. PA and lateral chest x-rays on the left.

View larger version (82K): [in this window] [in a new window]   Figure 2. PA and lateral chest x-rays on the right.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Curtis, A. B. Articles by Cutro, R. G. Search for Related Content PubMed PubMed Citation Articles by Curtis, A. B. Articles by Cutro, R. G. Related Collections Arrhythmias, clinical electrophysiology, drugs Cerebrovascular disease/stroke Ablation/ICD/surgery Pacemaker Other diagnostic testing Acute Stroke Syndromes Embolic stroke