We report a 64-year-old man with atrial fibrillation and impaired left vent
ricular function in whom pacemaker lead manipulation during biatrial pacema
ker lead removal and biventricular pacemaker lead insertion caused coronary
sinus dissection. After further manipulation of the biventricular pacing l
ead the true lumen of the coronary sin us could be entered and satisfactory
left ventricular pacing undertaken. The dissection was managed conservativ
ely without long-term sequelae.