Peritoneal migration of an epicardial pacemaker

A newborn with complete congenital atrioventricular block of immune origin, in severe heart failure, was implanted with a pacemaker at 1 day of life. The pacing lead was fixed to the epicardial right ventricle and the generator conventionally implanted in a pocket created beneath rectus muscles.

When the newborn was 4 years old, she was admitted to the hospital for syncope and the electrocardiogram showed complete atrioventricular block with visible spikes failing to capture the ventricle. Surprisingly, the device could not be detected by the programmer head. An X-ray was performed showing a migration of the generator resulting in lead traction. Knowing the actual location of the device, new interrogation was successful showing an increase in pacing threshold at 3.5 V.

An increase in pacing threshold due to generator displacement and lead traction was suspected and a surgical management was decided. An intraperitoneal migration of the device into the Douglas cavity was discovered. The material was explanted and a new dual chamber epicardial pacemaker was placed, with the generator implanted in a left retropectoral pocket. She was discharged from the hospital without complication and remained free of syncope after 1-year follow-up.

The full-length version of this report can be viewed at: http://www.escardio.org/Guidelines-&-Education/E-learning/Clinical-cases/Electrophysiology/EP-Case-Reports.