Pseudonormal Position of an Atrial Pacemaker Lead Associated With a Contralateral Pneumothorax

An 83-year–old man with coronary artery disease was hospitalized for syncope due to sick sinus syndrome and underwent dual-chamber pacemaker implantation. An axillary vein was accessed using venography in the absence of a cephalic vein. A right ventricular screw-in lead (Medtronic 5076, Medtronic, Minneapolis, Minn) was inserted and placed easily in the right ventricular apex with a hydrophilic 0.038-inch guidewire retained. After positioning the right ventricular lead, an attempt to insert the sheath for the atrial lead over that wire proved challenging because of the narrow space beneath the clavicle. The guidewire became dislodged from the inferior vena cava to the superior vena cava and was readvanced into the right atrium using fluoroscopy in the anteroposterior view. A 7-French peel-away …