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August 29, 1977

Unusual Complication From a Cardiac Pacemaker

JAMA. 1977;238(9):969. doi:10.1001/jama.1977.03280100053024

WE PRESENT an unusual complication that resulted from pacemaker placement in the abdominal wall.

Report of a Case  An 86-year-old man was admitted to the hospital in January 1977 because of severe cramping abdominal pain, nausea, and vomiting, starting six hours earlier.In March 1972, a bipolar demand pacemaker was placed in the left lower abdominal quadrant between the peritoneum and the deep fascia, because of complete heart block. The abdominal site was chosen because a pacemaker previously placed in the right anterior chest wall became infected. The abdominal pacemaker functioned well until September 1974, when the rate slowed spontaneously. A chest x-ray film showed a broken lead. Surgery was then performed and the lead found to be conducting poorly. This lead was capped, creating a unipolar system.On this present admission, physical examination disclosed blood pressure, 120/90 mm Hg; pulse rate, 96 beats per minute; respirations, 32/min; and temperature,