Abstract
BackgroundInvoluntary muscle contraction caused by extracardiac stimulation is a rare complication induced by a pacemaker. We report a case who developed sudden onset diaphragmatic contractions during general anesthesia caused by a DDD mode pacemaker.Case presentationA 74-year-old woman with a permanent pacemaker was scheduled to undergo mastectomy. The pacing mode was switched from DDD to VOO intraoperatively to avoid electromagnetic interference. Immediately after returning the pacing mode to DDD after surgery, diaphragmatic contractions occurred, mimicking bucking type of movements. After switching the pacing to A-sense V-pace, the twitching ceased. Because no structural problems were noted, and the twitching disappeared after terminating atrial pacing, diaphragmatic contractions might be caused by stimulation of the right phrenic nerve located near the right appendage where the electrode was installed.ConclusionThe potential risk of muscle twitching should be carefully evaluated preoperatively especially in patients with atypical position of pacemaker leads.
Highlights
Involuntary muscle contraction caused by extracardiac stimulation is a rare complication induced by a pacemaker
We report a rare case with a dual-chamber pacemaker who developed sudden onset diaphragmatic contractions during general anesthesia
Prior to recovery from general anesthesia, the pacemaker was programmed to the preoperative setting, in DDD mode at a pacing rate of 60–120 beats/min
Summary
Involuntary muscle contraction caused by extracardiac stimulation is a rare complication induced by a pacemaker. Conclusion: The potential risk of muscle twitching should be carefully evaluated preoperatively especially in patients with atypical position of pacemaker leads. We report a rare case with a dual-chamber pacemaker who developed sudden onset diaphragmatic contractions during general anesthesia. The pacemaker had been programmed in DDD mode at 60–120 beats/min with atrial output 1.5
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