Coronary sinus dislodgement

There is intermittent left ventricular capture noted on the rhythm strip (see Case 37 for further explanation). Given this, it was suspected that the left ventricular lead had become slightly dislodged. In fact, by the next morning the left ventricular lead was noted to be completely dislodged out of the coronary sinus anatomy. 

The current model of left ventricular coronary sinus lead has tines to help lodge itself in a coronary sinus vein. Even as such they only rarely dislodge in experienced hands. This particular lead had originally been placed in a lateral coronary sinus branch. 

---