NASHVILLE, Tenn. (AP) — Tennessee executed an inmate Tuesday without deactivating his implanted defibrillator, despite uncertainty about whether the device would shock his heart when the lethal chemicals took effect.

Byron Black died at 10:43 a.m., prison officials said. Shortly after the lethal injection started, witnesses said Black told a spiritual advisor in the room that he was hurting so badly. Black looked around the room as the execution started and could be heard sighing and breathing heavily.

Black was executed after a back-and-forth in court over whether officials would need to turn off his implantable cardioverter-defibrillator, or ICD. Black, 69, was in a wheelchair, suffering from dementia, brain damage, kidney failure, congestive heart failure and other conditions, his attorneys have said.___