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April 1, 1974

Late Displacement of Cardiac Pacemaker Electrode Due to Heavyweight Pulse Generator

Author Affiliations

From New York University School of Medicine, Department of Surgery, New York.

JAMA. 1974;228(1):74-75. doi:10.1001/jama.1974.03230260048025

ENDOCARDIAL pacing has been shown to be a satisfactory method for long-term cardiac pacing. The electrode complications of malposition, displacement, fracture, migration, and perforation have been well described in previous publications.1,2 We have recently observed a retraction of the endocardial electrode by the downward migration of the heavy pulse generator. This complication is prevented by anchoring the pacemaker to the clavicle or by creating a pacemaker "pocket" under the pectoral muscle or both.

Report of Cases  A 78-year-old man was admitted to New York University Hospital with intermittent heart block requiring cardiac pacing. A Medtronic pacemaker weighing 200 gm was inserted in a subcutaneous infrapectoral pocket with a bipolar electrode inserted via the cephalic vein into the apex of the right ventricle. Postoperatively the patient did well until the 12th month when failure of capture was noted.Chest x-ray film showed retraction of the catheter into the right atrium