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June 17, 1974

Pacemaker Twiddling

Author Affiliations

San Diego, Calif

JAMA. 1974;228(12):1521. doi:10.1001/jama.1974.03230370019009

To the Editor.—  Kim et al (228:74, 1974) suggest that the new titaniumcoated Medtronic pacemakers may cause electrode migration because of their increased weight. That may be true, but it is clearly not the case in the second patient they presented. In both Fig 1 and 2, the proximal end of the electrode overlies the ninth rib posteriorly; while the unit has rotated in Fig 2, it has not dragged the electrode with it.A more likely cause of the tip migration in Fig 2 is suggested by the spiral twist seen in its midportion; the patient (or her spouse) has been playing with the pacemaker. The electrodes are quite resistant to torque, and it takes only about eight complete rotations of the unit to produce the twist shown. The twist, in turn, shortens the electrode, withdrawing it from the heart; pacing failure ensues. I know of no other mechanism