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Terrence P. HORRIGAN, MD
Case Western Reserve University School of Medicine Cleveland

JAMA. 1979;242(4):322-323.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Excessive mobility of a pacemaker pulse generator in its subcutaneous pocket has produced lead dislodgement in the pacemaker twiddler's syndrome,^1,2 in which the patient rather absentmindedly winds and twists the electrode about the generator, retracting it from the cardiac chamber. An excessively mobile generator has also been reported to flip, causing failure of recharging in a rechargeable system.³ This report describes another sequel to an overly mobile generator—sudden onset of pectoral stimulation caused by a flip of a unipolar generator.

Report of Cases.—CASE 1.—

A 56-year-old man with sick sinus syndrome had a unipolar transvenous pacemaker system implanted through the cephalic vein in September 1976, with the pulse generator placed subcutaneously. Because of pectoral stimulation noted at implantation, the pulse generator was encased in a silicone rubber "boot," which limited the anodal metal surface of the generator to a small square that faced the subcutaneous . . . [Full Text PDF of this Article]

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