Acute cholestatic hepatitis and the sudden rise of the pacing threshold 5 weeks after VVI-pacemaker implantation

The patient we describe developed a cholestatic hepatitis and an unusual threshold elevation of about 425%, coincidently, 5 weeks after pacemaker implantation. Lead dislocation, myocardial infarction or metabolic disorder could be excluded as a reason for the pacemaker complication. Neither a biliary obstruction nor an infection of the liver could be found to explain the liver injury. Most probably, both disorders were caused by propafenone (450 mg day-1), withdrawal of the drug resulted in normalization of elevated enzyme and threshold levels.