Biventricular pacing in conjunction with epicardial atrial pacing adversely affects timing of intra-aortic balloon pump

A case of accidental triggering of an intra-aortic balloon pump during systole is presented. The patient had a cardiac resynchronization therapy device in place preoperatively for heart failure. A temporary epicardial atrial pacing wire was used during separation from cardiopulmonary bypass for rate control. An intra-aortic balloon pump was necessary for separation from bypass. Although the pacemaker functioned properly, the intra-aortic balloon triggered from the atrial pacing spike and was inflated during systole. Pacemaker and intra-aortic balloon electronics and timing settings that caused this are discussed in detail. Suggestions for prevention are presented.