Atrial pacing wires: an uncommon cause of postoperative hiccups

Abstract

A 60-year-old man was admitted to the cardiac intensive care unit following elective coronary artery bypass grafting. His past medical history included ischaemic heart disease and hypertension. Persistent bradyarrhythmias had necessitated temporary pacing before termination of cardiopulmonary bypass. This was achieved using right atrial epicardial pacing wires. On admission to the unit he was being paced at 80 beats per minute with a blood pressure of 132/68 mmHg, central venous pressure of 9 mmHg and an arterial oxygen saturation of 98%. The immediate postoperative period was uneventful and he was weaned off ventilatory support as per departmental protocol. Following extubation the patient complained of hiccups. On examination he had diaphragmatic contractions only on the right side synchronous with the pacing rate. At this point, as his heart rate had increased the pacing rate was reduced. This reduced the frequency of hiccups and switching off the pacemaker lead to the resolution of hiccups.