“The Thrill is Gone”

An 87-year-old woman underwent placement of a permanent pacemaker for recurrent near-syncope and sick sinus syndrome. Left subclavian vein access was difficult to obtain despite multiple attempts, and the pacemaker was ultimately placed on the right side. After surgery, the patient developed a mediastinal hematoma necessitating transfusion. No other acute interventions were required. Over the next 8 weeks, the patient developed progressive …