Key result
In a 64-year-old male with a single-chamber ICD, rhythmic abdominal twitching was caused by right phrenic nerve capture due to lead retraction, which resolved immediately when pacing was turned off.
Case Report (n=1)
Highlights the importance of optimal lead anchoring to the suture sleeve to prevent lead retraction and subsequent phrenic nerve capture.
Lead position warrants assessment in ICD patients with abdominal twitching; this case leaves open whether optimized anchoring reduces phrenic capture risk.
A 64-year-old male with a single-chamber ICD, implanted 3 months prior (Panel A), presented with sudden onset rhythmic abdominal twitching. Physical exam was notable for diaphragmatic contractions. A chest X-ray demonstrated lead retraction into the superior vena cava-right atrial junction (Panel B, arrow). Onset of symptoms correlated to a sudden drop in ventricular sensing (Panel C). Loss of sensing and capture was also noted on the ECG (Panel D, pacing artefact denoted by arrows). Symptoms resolved immediately with pacing turned off. Fluoroscopy demonstrated right-sided diaphragmatic stimulation during ventricular pacing prior to lead revision (see the movie file available in supplementary material online), consistent with right phrenic nerve capture. Lead dislodgement was due to suboptimal anchoring of the lead to the suture sleeve. Supplementary material is available at Europace online. Conflict of interest: none declared.
No takes yet. Share an insight, caveat, or question.
Miller et al. (2009) conducted a case report in ICD lead retraction and right phrenic nerve capture (n=1). Turning off pacing / Lead revision was evaluated on Resolution of symptoms. In a 64-year-old male with a single-chamber ICD, rhythmic abdominal twitching was caused by right phrenic nerve capture due to lead retraction, which resolved immediately when pacing was turned off.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: