Pacemaker electrode perforation of the myocardium: an unusual etiology for recurrent abdominal pain

A 79-year-old man with a permanent pacemaker presented on five separate occasions to the emergency department with recurrent episodes of crampy abdominal pain. Extensive radiographic studies and repetitive labwork were nondiagnostic. Shortly after hospital admission on the fifth visit he experienced cardiac arrest and was successfully resuscitated. Poor pacemaker capture and paced clonic contractions of the diaphragm and abdominal wall were noted, suggesting myocardial perforation by the pacemaker electrode. A new lead and pulse generator were implanted and the patient was discharged without further abdominal discomfort. Implications of pacemaker electrode perforation of the myocardium are discussed.