Alternating capture of the ventricle and an unusual pacing rate

The recent improvements in technology of cardiac pacing are often responsible for difficult electrocardiograms at follow-up (Gladstone et al., 1987). Therefore, it seems an advantage that most modern pacemakers include diagnostic software functions to explain the pacing behaviour (event markers, intracardiac electrograms...). In this case report an electrocardiogram, showing pacing dysfunction of a physiologic pacemaker with rate response is presented. It was possible to understand what was happening without electrograms, but confirmation of our interpretation of the pacing behaviour was only possible with telemetric data.