Zhang XS, Wang F, Qi XW, Shafii P, Cui XN, Wang YH. Phrenic nerve capture caused by atrial electrode dislodgement: A case report. World J Cardiol 2026; 18(4): 118863 [DOI: 10.4330/wjc.v18.i4.118863]
Corresponding Author of This Article
Yue-Hai Wang, MD, Associate Professor, Chief Physician, Department of Cardiology, Liaocheng People’s Hospital and Liaocheng Hospital Affiliated to Shandong First Medical University, No. 67 Dongchang West Road, Liaocheng 252000, Shandong Province, China. wyh_1234567@126.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Apr 26, 2026 (publication date) through Apr 14, 2026
Times Cited of This Article
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Journal Information of This Article
Publication Name
World Journal of Cardiology
ISSN
1949-8462
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhang XS, Wang F, Qi XW, Shafii P, Cui XN, Wang YH. Phrenic nerve capture caused by atrial electrode dislodgement: A case report. World J Cardiol 2026; 18(4): 118863 [DOI: 10.4330/wjc.v18.i4.118863]
Xue-Song Zhang, Department of Cardiology, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
Fei Wang, Department of Cardiology, Shandong Corps Hospital of Chinese People’s Armed Police Forces, Jinan 252000, Shandong Province, China
Xue-Wen Qi, Pella Shafii, Xiao-Ning Cui, Yue-Hai Wang, Department of Cardiology, Liaocheng People’s Hospital and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng 252000, Shandong Province, China
Author contributions: Zhang XS collected the case materials and participated in writing the manuscript; Wang F participated in the discussion of the medical records and in writing the manuscript; Qi XW contributed to the case discussion and verified the materials; Shafii P participated in the case discussion and in polishing the manuscript; Cui XN participated in collecting the case materials; Wang YH was involved in collecting and discussing the case materials, as well as in writing and revising the manuscript; and all authors have read and approved the final manuscript.
Supported by Key Research and Development Plan Policy Guidance Projects in Liaocheng City, No. 2024YD24; and 2025 Liaocheng Health Policy Research Project.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Yue-Hai Wang, MD, Associate Professor, Chief Physician, Department of Cardiology, Liaocheng People’s Hospital and Liaocheng Hospital Affiliated to Shandong First Medical University, No. 67 Dongchang West Road, Liaocheng 252000, Shandong Province, China. wyh_1234567@126.com
Received: January 14, 2026 Revised: February 24, 2026 Accepted: March 18, 2026 Published online: April 26, 2026 Processing time: 90 Days and 23.1 Hours
Abstract
BACKGROUND
Atrial electrode lead dislodgment leading to phrenic nerve capture is rare.
CASE SUMMARY
An elderly man with third-degree atrioventricular block underwent dual-chamber pacemaker implantation. During the procedure, both leads were introduced through the same venous puncture site. A passive lead was positioned in the atrium, and an active lead was positioned in the ventricle. On postoperative day 3, the patient developed diaphragmatic flutter. Electrocardiography demonstrated poor atrial sensing. Repeat chest radiography and computed tomography revealed displacement of the atrial lead compared with its immediate postoperative position, while the ventricular lead remained stable. Device interrogation confirmed abnormal atrial sensing. The frequency of diaphragmatic flutter varied according to the programmed atrial pacing rate, whereas ventricular sensing and pacing thresholds were normal. After reprogramming the device to ventricular inhibited pacing mode, the diaphragmatic flutter resolved completely.
CONCLUSION
Atrial electrode lead displacement may capture the phrenic nerve, leading to diaphragmatic flutter.
Core Tip: During the dual-chamber pacemaker implantation through the same venous puncture site, a passive lead was positioned in the atrium and an active lead was positioned in the ventricle. The patient developed diaphragmatic flutter postoperatively. Electrophysiological evaluation confirmed poor atrial sensing. The frequency of diaphragmatic flutter varied according to the programmed atrial pacing rate, whereas ventricular sensing and pacing thresholds remained normal. After reprogramming the device to VVI mode, the diaphragmatic flutter resolved completely. X-ray examination revealed atrial lead displacement. The displaced atrial lead triggered diaphragmatic flutter by stimulating the phrenic nerve.
