Phrenic nerve stimulation, a rare complication of pacemaker: A case report.

RATIONALE The phrenic nerve stimulation (PNS) is a rare complication after pacemaker setting. We report a case report that describes this complication and how it can be resolved. PATIENT CONCERNS An 88-year-old man presented himself to the emergency geriatric unit with intermittent painless abdominal contraction due to phrenic nerve stimulation. He has a history of transcatheter aortic valve implantation with cardiac resynchronization therapy pacemaker due to persistent left bundle branch block. DIAGNOSES All the usual causes for abdominal spasms were eliminated and the possibility of a link with the pacemaker was considered. The phrenic nerve stimulation is a rare complication of a pacemaker implantation. It can be clinically nonrelevant but challenging to diagnose for those not familiar with cardiac devices technology. INTERVENTIONS Initial setting was an axis of stimulation between distal left ventricular (LV) and right ventricular. It was changed to LV and D1-M2. OUTCOMES This noninvasive procedure managed to eradicate the involuntary abdominal spasms. LESSONS PNS could be challenging to diagnose for those not familiar with cardiac devices technology but easy to manage with noninvasive methods.