Document Type

Report

Publication Date

7-27-2025

Comments

This article is the author’s final published version in Oxford Medical Case Reports, Volume 2025 Issue 7, 2025, Article number omaf117.

The published version is available at https://doi.org/10.1093/omcr/omaf117. Copyright © The Author(s) 2025.

Abstract

Introduction: Leadless intracardiac pacemakers (LICPs) reduce lead-related complications but may be malpositioned in patients with unrecognized structural defects. We report a 69-year-old man with high-grade AV block whose LICP, intended for right ventricular placement, was found in the left ventricle via an undiagnosed ostium secundum ASD after presenting with multifocal embolic strokes 16 months later. Case Presentation: Stroke workup for acute right-sided symptoms revealed the LICP in the LV and a large, previously undiagnosed ASD with bidirectional shunting and severe pulmonary hypertension. Embolic infarcts were attributed to either paradoxical embolism or device-related thromboembolism. Due to high surgical risk, the device was left in place; heparin was started with plans to bridge to warfarin. The patient later declined percutaneous ASD closure. Conclusion: This case highlights the risk of LICP misplacement via an unrecognized ASD and underscores the need for structural evaluation before implantation, even without clinical suspicion.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Language

English

PubMed ID

40718539

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