Intra-pleural epicardial pulse generator: A management conundrum at end-of-life

Twenty-three years previously, a 32-year-old man underwent epicardial pacem aker implantation with placement of the pulse generator in the pleural cavi ty, this unusual pulse generator location necessary since his previous endo cardial pacemaker had been complicated by recurrent erosion, migration and, eventually, infection. Over two decades later, the pulse generator reached end-of-life characteristics but the patient was unkeen to undergo:a thorac otomy for box change. He underwent implantation of a new endocardial system with implantation of the pulse generator subcutaneously in the left pector al region. His original epicardial intra-pleural pulse generator was left i n situ.