'Size it and fix it': pulsatile abdomen and presyncope post pacemaker implantation

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Permanent pacemaker implantation is a common procedure for bradyarrhythmias.
• VVIR pacing mode is utilized for specific cardiac conditions.
• Recent pacemaker surgery carries potential risks and complications.

Observation:

• A 69-year-old obese male presented with a one-day history of symptoms.
• The patient reported forceful abdominal pulsations.
• Presyncope (near-fainting) was also reported by the patient.

Findings:

• The patient had undergone permanent pacemaker implantation (VVIR, Medtronic) three weeks prior to presentation.
• The constellation of symptoms suggests a possible complication related to the pacemaker or its implantation.
• Potential causes include lead dislodgement, perforation, or an interaction between the pacemaker pulse generator and abdominal structures.

Implications:

• Prompt diagnostic workup is crucial to identify the cause of the symptoms.
• Management may involve device interrogation, imaging, or surgical intervention.
• This case highlights the importance of considering device-related complications in patients presenting with new-onset symptoms post-pacemaker implantation.