Treatment of a malpositioned transcutaneous ventricular pacing lead in the left ventricle via direct aortic puncture

An 81-year-old woman with progressive cough was hospitalized 2 weeks following transcutaneous pacemaker implantation. Imaging revealed an absent brachiocephalic vein and aberrant course of a ventricular lead into the aorta with implantation into the left ventricle. We describe the unusual anatomic course, diagnosis, and surgical extraction of a malpositioned pacer lead.