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A 65-year-old man with a dual-chamber pacemaker placed for sick sinus syndrome had 2 subsequent strokes attributed to inadvertent left ventricular pacemaker lead placement. This apical 4-chamber view from a transthoracic echocardiography demonstrates traversal of the lead across the interatrial septum. The patient was anticoagulated with warfarin to an international normalized ratio of 2.5 to 3.5 with no further embolic events. Click the related article link for an additional transthoracic echocardiography video demonstrating left-to-right shunt through the septum and for full case details.
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