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A 63 year old woman was admitted with an inferior myocardial infarction complicated by complete heart block. A transvenous temporary pacing wire was inserted via the right subclavian vein and the procedure proceeded without problem. Chest x ray on completion of the procedure is shown below and the wire position appeared reasonable. She was pacing satisfactorily, however, with a right bundle branch block pattern and we therefore arranged for her to have an echocardiogram. Her echocardiogram revealed the pacing wire to have crossed the interventricular septum and lie in the left ventricle as shown.
The temporary wire was removed without difficulty and the patient went on to have a permanent pacing system inserted several days later without further complication.