Iatrogenic ventricular tachycardia from endocardial pacemaker late after repair of tetralogy of Fallot

A 34-year-old woman, who had undergone radical repair for tetralogy of Fallot at the age of 8 years, was left with moderate-to-severe pulmonary regurgitation. VT developed after endocardial pacing for symptomatic pauses and atrial flutter. The possibility that the new VT originated from the apical endocardial lead was suggested by the unusual morphology of the VT, which was similar to paced. Surgical removal of the lead, which was deeply embedded at the same time as a pulmonary valve was replaced, cured the arrhythmia. This unusual cause of VT highlights possible risks associated with setting up a dangerous reentry circuit by inserting a right ventricular endocardial pacemaker lead.