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# Lead detour

L. M. van den Broek · S. W. Westra · R. Evertz · M. Boulaksil

Published online: 12 August 2019

© The Author(s) 2019

A 48-year-old male was brought to our Emergency Department after a car accident due to syncope. His medical history included paroxysmal atrial fibrillation and a bicuspid aortic valve requiring aortic valve replacement with a mechanical prosthesis. At presentation, the electrocardiogram showed a new third-degree atrioventricular block. It was decided to implant a dual-chamber pacemaker, but the procedure was more challenging than expected. Fig. 1 shows the position of the leads at the end of the procedure. What is your diagnosis?

## Answer

You will find the answer elsewhere in this issue.

**Conflict of interest** L.M. van den Broek, S.W. Westra, R. Evertz and M. Boulaksil declare that they have no competing interests.

**Open Access** This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

<figure><img src="image_2.png" /><figcaption>Fig. 1 Radiograph showing final lead position in our patient</figcaption></figure>

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