Pacemaker Dependence Masking Atrial Fibrillation in a Case of Infective Endocarditis

Pacemaker dependence can complicate the diagnosis of underlying arrhythmias, posing a significant challenge for emergency providers, especially when atrial fibrillation (AF) is masked by pacemaker activity. This is particularly concerning in patients with a history of cardiac surgery, such as tissue aortic valve replacement, and those presenting with potential infective endocarditis (IE). This case study examines a patient who presented to the emergency department with symptoms suggestive of endocarditis following recent dental work, but whose new-onset AF went undiagnosed due to pacemaker settings and dependence. This case highlights the diagnostic challenges posed by pacemaker-dependent rhythms and underscores the importance of emergency department pacemaker interrogations and comprehensive evaluation in patients with complex cardiac histories. Additionally, it raises awareness of the need for heightened suspicion for both arrhythmias and infections in such patients, particularly in resource-limited settings where specialized consultations may not be readily available.