Upper limit ventricular stimulation in respiratory rate responsive pacing due to electrocautery

Transient programmed upper limit stimulation (150 bpm) was observed during repetitively utilized electrocautery in the beginning of an open-heart surgical procedure in a patient with a minute ventilation rate responsive ventricular pacemaker. This tachycardia caused severe hemodynamic deterioration, and was also initiated by internal heart massage and manual ventilation. Considering the recommendations of the manufacturer, this series of serious events could have been prevented, when reprogramming to the inhibited mode had been executed in anticipation of the operation.