Malposition of cardiac pacemaker wires is an occasional complication of transvenous pacing. Two-dimensional echocardiography can provide a noninvasive means of visualizing pacemaker wire position' and a recent article by Gondi and Nanda demonstrated that the technique can provide an accurate assessment of pacemaker wire displace-menL2 The following report further illustrates the usefulness of this technique and also demonstrates that a pacemaker wire positioned within the left ventricle can be free of complications over a long period.
CASE REPORT
A 72-yr-old man with a history of a cardiac murmur and a neurologic diagnosis of Charcot-Marie-Tooth syndrome presented with symptoms of transient dizziness in November 1977. A diagnosis of paroxysmal atrial fibrillation was made and noninvasive studies confirmed the presence of a secundum atrial septal defect. An incomplete right bundle branch block pattern was present on the electrocardiogram and the physical findings were compatible with the diagnosis of a septal defect. Medical management with Digoxin was recommended.
Six months later, his symptoms of presyncope returned and Holter monitoring revealed the presence of brief bouts of paroxysmal atrial tachycardia often followed by periods of sinus arrest lasting up to 5 sec. In June 1978, a permanent transvenous pacemaker was implanted. At