Anatomical context of left anterior descending artery and right ventricular lead implanted apparently in the midseptal position – Case report

Septal pacing is considered to be more physiological compared to pacing of the apex of the right ventricle (RV). However, correct placement of the RV lead into the septum is often difficult using only fluoroscopic criteria during implantation; and many leads are in fact anchored in the anterior or free wall of the RV. In our case report we would like to show that unintentional implantation of the RV lead into the anterior wall can endanger left anterior descending artery, because of its close anatomical relation.