Three-dimensional echocardiography definitively delineates a malpositioned permanent pacing lead in a patient with chronic chest pain.

Inadvertent malpositioning of a cardiac pacing lead into the left heart chambers is a rare complication of transvenous pacing. We report a patient with a history of a transient ischemic attack and chronic chest pain whose left atrial pacing lead location was revealed by transesophageal three-dimensional (3D) echocardiography during evaluation of an inter-atrial shunt.