Abstract
The late onset of diaphragmatic stimulation without apparent intercostal muscle stimulation caused a pacemaker sound in a patient with a transvenous pacemaker in the absence of obvious myocardial perforation. In this situation the pacemaker sound does not invariably indicate myocardial perforation. Serial ventricular electrograms may be helpful in detecting changes in catheter position and in the diagnosis of myocardial perforation. Some manipulation of the pacing catheter is often required to eliminate uncomfortable diaphragmatic stimulation whether or not perforation has occurred. The late onset of diaphragmatic stimulation without apparent intercostal muscle stimulation caused a pacemaker sound in a patient with a transvenous pacemaker in the absence of obvious myocardial perforation. In this situation the pacemaker sound does not invariably indicate myocardial perforation. Serial ventricular electrograms may be helpful in detecting changes in catheter position and in the diagnosis of myocardial perforation. Some manipulation of the pacing catheter is often required to eliminate uncomfortable diaphragmatic stimulation whether or not perforation has occurred.
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