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Sports Medicine

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1000 - Golf Swing-Induced Pacemaker Atrial Noise and Extraction: Description of Mechanism and Case Report

Thursday, February 22, 2024
5:00 PM – 6:30 PM EDT
Case Diagnosis: Dysfunction of cardiac pacemaker system due to golf swing


Case Description: An 81-year-old male golfer with a history of atrial fibrillation, congestive heart failure, and sick sinus syndrome presented with atrial lead noise. The patient underwent initial dual-chamber pacemaker implantation in 2009. However, he underwent lead extraction and reimplantation in 2019 due to atrial lead noise during specific arm movements, and interrogation of the pacemaker and initial testing failed to reveal the triggering activity. Later, cardiac electrophysiology testing reproduced the noise exclusively when simulating a golf swing, involving left arm crossing, hands adjoining, and swing mimicry. In 2023, the right ventricular lead was switched to unipolar due to right ventricular impedance drop. Ongoing pacemaker lead irritation mandates imminent lead replacement.



Discussions: To our knowledge, this is the first reported instance of golf swing-induced right ventricular lead failure. Mechanistically, the golf swing's biomechanical forces may affect lead positioning, causing intermittent lead contact. Repetitive oscillations with each swing may have induced cumulative microdamage, causing insulation breaks and lead failure, prompting impedance shifts. Given the recurrence of dysfunction, persistent improper golf swing mechanics and inadequate rehabilitation to optimize scapulohumeral rhythm and strength are likely responsible. In older patients with pacemakers who present to PM&R providers, muscle tightness and weakness can be common and may affect biomechanics. This case illustrates the importance of a comprehensive neuromusculoskeletal exam to identify biomechanical asymmetries, leading to changes in exercise and rehabilitation prescriptions, allowing patients to maintain an active lifestyle.



Conclusions: This case highlights the need for tailored evaluation in individuals with device-related symptoms in regard to sport-specific movements, especially when traditional stressors fail to reproduce symptoms. This report advances our understanding of device interactions with mechanical motions and underscores the need for further investigation into the underlying mechanisms and protocols for treatment and prevention.