[33 years of pacemaker longevity-an unusual case]

We report on an 86-year-old patient whose unipolar single-chamber pacemaker (Vitatron Ceryx 623), implanted in 1991 due to sinus node arrest, had been continuously active for 33 years without any replacement of the pacemaker unit. No routine outpatient check-up had been carried out for over a decade. The ECG revealed asynchronous ventricular pacing (VOO) at a fixed rate of 50/min, consistent with the manufacturer's defined EOS fallback mode. Despite the failure to switch modes, the patient remained clinically event-free. Upon replacement of the device, complete shell-like calcification of the pocket ("porcelain pocket") was observed; the lead measurements (stimulation threshold 0.5 V/0.4 ms, sensing 7.2 mV, impedance 351 Ω) were excellent, thus the lead was left in place. This case illustrates the remarkable long-term performance of older devices and leads, at the same time it underlines the need for a regular follow-up and the risks of asynchronous pacing in EOS mode.