Three weeks ago we implanted one of the G-E Pacemakers which you helped to develop. I want to thank you for the detailed instructions
which accompanied your instrument. This makes the procedure much easier than it would be without them.
We had a complication which I have not seen mentioned in the literature and I would appreciate your comments on this. With
the electrodes in place high on the left ventricle we loosely approximated the edges of the pericardium and were preparing
to close the chest when it was noted that the left diaphragm was contracting each time the heart beat. We then found that
the electrodes lay beneath the phrenic nerve which coursed very close to the pulmonary hilum. The pericardium was opened but
even with the phrenic pulled back from the electrode it was still stimulated by the electrode touching the pericardium. We
hesitated to place a sponge over the electrodes for fear of promoting too much scarring about them and were hesitant to try
to reroute the nerve for fear that it might return to contact with the electrodes after the chest was closed. We finally crushed
the nerve as it entered the diaphragm. This of course controlled the hiccups but I dislike paralyzing the phrenic unnecessarily,
particularly in a somewhat obese person as was this woman. So far everything has gone well and we are waiting to see what
happens when the nerves has had time to regenerate. This lady had a preoperative rate of 26 to 30 which was not affected by
any of the drugs tried by the internists here.