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A man in his 90s with a history of hypertension, hypercholesterolemia, sinus node dysfunction, and prior dual-chamber pacemaker implantation presented with 1 month of abdominal pain radiating to his back. The initial chest radiograph demonstrated a dual-chamber permanent pacemaker with an atrial lead in the right atrial appendage and ventricular lead at the right ventricular (RV) apex. A computed tomography angiogram demonstrated a 5.3 × 5.3-cm infrarenal abdominal aortic aneurysm with thrombus. The patient was urgently taken to the operating room for percutaneous endovascular aneurysm repair.
Aziz Z, Mikolajczak P, Hauptman PJ. A Case of Possible Pacemaker Undersensing. JAMA Intern Med. 2015;175(6):1050-1052. doi:10.1001/jamainternmed.2015.0174