Kerala Heart Journal -Anurag

Case report

Kerala Heart J  2016; 6(2):xx-xx. 

Right ventricular apical mass after pacemaker implantation

Anurag Bahekar*, Sajan Ahmad Z*, George Koshy*, K. Venugopal*, Jacob Therakathu**

*Dept.of Cardiology    ** Dept.of Radiology, Pushpagiri Medical College, Tiruvalla, Kerala

Corresponding author

Dr Anurag Bahekar

Senior Resident

Department of Cardiology

Puspagiri Institute of medical sciences,  Thiruvalla, Kerala

Case history:

46-year-old gentleman, a case of symptomatic high degree AV block on temporary pacemaker via right femoral venous access (for 4 days) underwent a permanent pacemaker (VDDR) implantation via left subclavian venous access.



Echocardiography post procedure showed a mobile structure attached to the RV apical endocardium, near the insertion of the pacemaker lead.


Differential diagnosis:

1.      Thrombus at site of RV lead

2.      RV trabecular tear

3.      Endocardial vegetation



         Patient had no history of fever.

ESR value - 20mm/hr. (unlikely to be vegetation)

         Echo density of the mobile structure appeared similar to that of RV trabeculae



         Planned for Cardiac MRI/CT for tissue characterization

CT was done (as pacemaker was not MRI compatible).  Due to extensive pacemaker lead artifacts, CT images were non-contributory.      

         Oral anticoagulation was started in view of possibility of RV apical thrombus

         Follow up echo.



            2D echo at 3 weeks interval showed significant regression of the mobile structure, suggesting that thrombus could be the most possible etiology

Figure 1

Figure 2



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