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Left Ventricular Malposition of Pacemaker Lead in Chagas' Disease

A 52‐year‐old Argentinian woman presented with third‐degree AV block due to seropositive chronic stage of Chagas' disease. Subsequently, a DDD pacemaker was implanted. Interestingly, a postoperative chest X ray suggested left ventricular lead misplacement, an ECG showed a paced RBBB. Echocardiography confirmed suspected lead malposition in the left ventricle with perforation of a large aneurysm of the interatrial septum that might be related to Chagas' disease. The ventricular lead was successfully repositioned in the right ventricle. Therefore, to avoid lead malposition in Chagas' disease structural cardiac defects should always be ruled out before operation. If a paced RBBB indicates malposition, different fluoroscopic projections should be used to verify lead position.