• Meddy Dalex, Astrid Malezieux, Thibault Parent, Dina Zekry, and Christine Serratrice.
• Division of Internal Medicine for the Aged.
• Medicine (Baltimore). 2021 Mar 19; 100 (11): e25060e25060.

RationaleThe 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 ConcernsAn 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.DiagnosesAll 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.InterventionsInitial setting was an axis of stimulation between distal left ventricular (LV) and right ventricular. It was changed to LV and D1-M2.OutcomesThis noninvasive procedure managed to eradicate the involuntary abdominal spasms.LessonsPNS could be challenging to diagnose for those not familiar with cardiac devices technology but easy to manage with noninvasive methods.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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