"Pacemaker heart sound" caused by diaphragmatic contractions

Newly developed systolic murmur in patients with a transvenous pacemaker

We encountered four cases in which a transvenous cardiac pacemaker produced a systolic musical murmur in the absence of any complications. This systolic murmur appeared only when the pacing was being cut off and disappeared soon after the pacing had been turned on. Although the exact mechanism of production of the murmur remains uncertain, several possible mechanisms for its occurrence are discussed. It is apparent from this study that a systolic murmur can newly occur without any obvious cause in patients with a transvenous pacemaker.

Pacemaker-induced endocardial friction rub

Two patients had a typical sounding cardiac friction rub after placement of a temporary transvenous pacemaker. Absence of myocardial perforation was documented in one patient during thoracotomy for placement of an epicardial electrode and in the other with an electrogram recorded from the pacemaker as it was being withdrawn. The rubs disappeared during pacemaker removal. These cases are believed to represent endocardial friction rubs resulting from contact of the pacing wire with the endocardium.