Sudden onset pacemaker-induced diaphragmatic twitching during general anesthesia

JA Clinical Reports
Kanae TanabeTakashi Matsukawa


Involuntary muscle contraction caused by extracardiac stimulation is a rare complication induced by a pacemaker. We report a case who developed sudden onset diaphragmatic contractions during general anesthesia caused by a DDD mode pacemaker. A 74-year-old woman with a permanent pacemaker was scheduled to undergo mastectomy. The pacing mode was switched from DDD to VOO intraoperatively to avoid electromagnetic interference. Immediately after returning the pacing mode to DDD after surgery, diaphragmatic contractions occurred, mimicking bucking type of movements. After switching the pacing to A-sense V-pace, the twitching ceased. Because no structural problems were noted, and the twitching disappeared after terminating atrial pacing, diaphragmatic contractions might be caused by stimulation of the right phrenic nerve located near the right appendage where the electrode was installed. The potential risk of muscle twitching should be carefully evaluated preoperatively especially in patients with atypical position of pacemaker leads.


Sep 17, 2020·Internal and Emergency Medicine·Damien NguyenEva De Keyzer
Sep 24, 2020·Journal of Cardiovascular Electrophysiology·Takayuki SekiharaHiroshi Tada

Related Concepts

General Anesthesia
Muscle Contraction
Artificial Cardiac Pacemaker

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