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To the Editor.—
Since the advent of electrical pacing of the heart, many unusual causes of malfunction have been recognized. This report also describes an unique emergency maneuver.
Report of a Case.—
A 70-year-old farmer had a left ventricular epicardial pacemaker implanted eight years ago. The generator pocket was in the upper abdomen, and the electrodes crossed the belt region in a subcutaneous tunnel. A few months later, the patient was brought to the emergency room because of repeated Stokes-Adams attacks particularly when in the supine position. His family noted that he had no syncopal episodes throughout the two-hour journey by car while in the sitting position. In the emergency room, he lost consciousness while supine, and ventricular standstill was recorded on his electrocardiogram. Sitting him forward or pressing his abdomen at the waist above the electrode, resulted in immediate resumption of electrical pacing. This was confirmed repeatedly under electrocardiographic
Abinader EG. Pacemaker Electrode Break: Emergency Treatment. JAMA. 1974;228(12):1520–1521. doi:10.1001/jama.1974.03230370018008
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