A 48-year-old male was brought to our Emergency Department after a car accident due to syncope. His medical history included paroxysmal atrial fibrillation and a bicuspid aortic valve requiring aortic valve replacement with a mechanical prosthesis. At presentation, the electrocardiogram showed a new third-degree atrioventricular block. It was decided to implant a dual-chamber pacemaker, but the procedure was more challenging than expected. Fig. 1 shows the position of the leads at the end of the procedure. What is your diagnosis?
Fig. 1.
Radiograph showing final lead position in our patient
Answer
You will find the answer elsewhere in this issue.
Conflict of interest
L.M. van den Broek, S.W. Westra, R. Evertz and M. Boulaksil declare that they have no competing interests.