We present a case of a 76-year-old female who
developed recurrent left-sided muscle spasms
resembling hiccups after permanent dorsal column
stimulator (DCS) implantation. The patient
had a cardiac resynchronization device with
defibrillating capabilities (CRT-D) in place, which
was interrogated before and after the permanent
DCS placement with no interference reported.
Due to the timing of the event with the placement
of the DCS, it was presumed that the spasms
were related to the DCS implantation, and removal
of the DCS was considered. However,
further evaluation by a cardiology consultant
revealed that a lead from her CRT-D was most
likely stimulating the phrenic nerve and causing
diaphragmatic contractions. The patient was sent
to the electrophysiology clinic where the voltage
on her left ventricular lead was reduced, and her
symptoms resolved completely. Due to the time,
risks, and expense of implanting a DCS, it is
imperative to consider all other possible causes
of diaphragmatic contractions prior to removing
a DCS system.
Key words: Dorsal column stimulator, cardiac
resynchronization therapy device, phrenic nerve
stimulation, hiccups, muscle spasms, diaphragmatic
contractions, interference
The Quadripolar Left Ventricular Lead: An Effective Alternative for Phrenic Nerve Stimulation
