Case 80

Abstract

A 73-year-old man underwent dual chamber pacing system implantation for intermittent advanced and complete AV block. His ejection fraction was normal, and he was not known to have any ventricular ectopy. Over the ensuing 6 months, pacemaker interrogation revealed normal dual chamber operation and no ventricular ectopy (designated PVE in this pacing system). One month after his last pacemaker clinic visit the patient began to note increasing effort fatigue and breathlessness. A thorough history and physical examination revealed no evidence of heart failure and was normal. A 12-lead ECG demonstrated sinus rhythm with first degree AV block and no evidence of atrial or ventricular pacing outputs. Interrogation of the pacemaker indicated over 700,000 PVEs occurring during the prior month, a totally unexpected finding for this patient (Fig. 80.1). © Springer-Verlag London Limited 2011.