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Stimulation of skeletal muscle is a fairly common complication of permanent cardiac pacing. The usual cause is direct apposition of the anode of a unipolar pacemaker with muscle surrounding the pocket. Other causes include electrode insulation defects and electrode displacement. In this report we describe an unusual cause of muscle stimulation related to direct current leakage from the pacemaker.

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Three patients were referred for urgent investigation and treatment of refractory arrhythmias. Each patient had failed to respond to antiarrhythmic drugs and in two patients direct current cardioversion was also unsuccessful. Transvenous ablation of atrioventricular conduction was therefore thought appropriate. With a temporary ventricular pacing system in situ, a second electrode was used to record His and atrial electrograms. A 270 watt-second shock was delivered through this lead when the His potential was maximized. The tachycardia was controlled in two patients and the procedure was without deleterious effects.