"Sagging heart syndrome": A cause of acute lead dislodgment in two patients

Acute passive fixation atrial lead dislodgment occurred due to an un expect ed and marked postural descent of the heart after permanent pacemaker impla ntation in two patients. Sagging of the heart in these two individuals may have been related to a history of morbid obesity followed by weight loss of oi er 100 pounds. Lead replacement with active fixation leads was required in both cases. The term "sagging heart syndrome" is proposed to describe t his clinical entity. In certain adult populations, such as in patients with a history of significant weight loss, the "sagging heart syndrome" may rep resent a previously unrecognized cause of acute lead dislodgment.