Cardiac Pacemaker—Apparently Disconnected
Chest radiography was carried out in an 86-year-old man to exclude pneumonia. On the image obtained, the right-sided ventricular electrode had no detectable connection with the pulse-generating unit on the left, although intermittently effective ventricular stimulation by the pacemaker was apparent on 12-lead ECG. The VVIR pacemaker had been implanted 8 years earlier to treat bradyarrhythmia in the presence of permanent atrial fibrillation. Originally placed on the right, in an operation performed elsewhere at the request of the patient, a keen hunter, the pulse generator had later been transferred to the left side of the thorax.
The original electrode was left in place and connected with the repositioned pulse generator via a subcutaneously tunneled unipolar electrode extension (dashed red line in the lower part of the image; the white arrow points to the plug connecting the extension to the pulse generator). The very thin electrode extension is hard to discern on the posteroanterior image, explaining the unusual initial impression.
In the event of such abnormal or unclear findings, chest radiographs should always be obtained in two planes.
Prof. Dr. med. Marc-Alexander Ohlow, Klinik für Kardiologie und internistische Intensivmedizin, SRH Wald-Klinikum Geramarc.firstname.lastname@example.org
Conflict of interest statement: The author declares that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Ohlow MA: Cardiac pacemaker—apparently disconnected.
Dtsch Arztebl Int 2020; 117: 404. DOI: 10.3238/arztebl.2020.0404