Phrenic Nerve Stimulation-Induced Persistent Singultus: A Case of Atrial Lead Dislodgement After Dual-Chamber...

Phrenic nerve stimulation is a rare but recognized complication of pacemaker implantation. The unique presentation of singultus in the presence of a pacemaker does not warrant initial concerns for pacemaker dislodgement, however in conjunction with muscle twitching and recent insertion of said pacemaker, lead dislodgement becomes more likely. We describe a 62-year-old male with history of right nephrectomy and recent placement of dual-chamber pacemaker for complete heart block presented seven days post procedure with right pectoralis muscle twitching and persistent singultus. Electrocardiogram showed an atrial-ventricular paced rhythm. Chest radiography revealed interval retraction of the right atrial lead with ventricular lead remaining in place. Device interrogation confirmed atrial lead dislodgement with subsequent phrenic nerve stimulation. The device was reprogrammed to ventricular-only pacing mode (VVIR), resulting in resolution of symptoms, however it was not a permanent solution. The patient was discharged with plans for outpatient lead revision. Atrial lead dislodgement can result in phrenic nerve stimulation and uncommon symptoms such as singultus and twitching of chest muscles. Prompt recognition of the underlying etiology and reprogramming of the pacemaker can alleviate symptoms and guide further management.