Pacemaker catheter induced systolic murmurs in two patients Hideo Yoshida 1 , Masayuki Inagaki 1 , Masaki Shukuya 1 , Nobutaka Doba 1 , Naotaka Shimizu 1 1Third Department of Medicine Teikyo University School of Medicine Ichihara Hospital pp.573-577
Published Date 1989/5/15
DOI https://doi.org/10.11477/mf.1404205484
  • Abstract
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Although extracardiac sounds secondary to cardiac pacing have been well known, the murmurs origina-ting in the heart after permanent pacemaker implan-tation and then disappearance after exchanging a temporary to permanent lead have rarely been reported. In this paper, two patients revealing a musical systolic murmur after placement of a trans-venous endocardial pacemaker in the absence of any complications were documented. Case 1 : A 43-year-old man with episodes of dizziness and brady-tachycardiac atrial fibrillation. Immediately after the implantation of a tempolary transvenous right ventricular pacemaker, a high-pitched systolic musical murmur was heard at the lower left sternal border. No murmur was however audible after a permanent pacemaker implantation in this case. Case 2 was a 83-year-old female with coronary heart disease associated with sick sinus syndrome to whom a permanent transvenous right ventricular pacemaker was inserted. A musical systolic murmur occurring immediately after the procedure was best audible at the apex. Although numerous papers concerning the mechanisms of these cardiac murmurs have been reported without reaching conclusive explanations, our data based on two cases examined with Doppler echocardiography did not support the idea of tricus-pid regurgitation as one of causative factors. In the first case, this murmur appeared only a temporary pacing was performed and disappeared after implan-tation of a permanent pacemaker lead. On the cont-rary, however, the 2nd case revealed after the im-plantation of the permanent pacemaker with a rela-tively rigid bipolar lead. It is concluded that these murmurs might be produced by vibrations caused by the pacing catheters and physical propeties could be related the mechanism of this phenomenon.

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