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[Reproducible ventricular flutter during programming of a DDD pacemaker]
B Bienstein1, W Grosse-Heitmeyer, M Liebetrau
1Medizinische Klinik-Kardiologie, St. Bonifatius-Hospital, Lingen.
Deutsche Medizinische Wochenschrift (1946)
|December 23, 1993
Summary
A patient with atrioventricular block developed life-threatening ventricular arrhythmias after pacemaker implantation. Increased sotalol dosage successfully managed these episodes, highlighting effective antiarrhythmic therapy.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- A 51-year-old woman with second-degree (Mobitz type) atrioventricular block received a bipolar DDD pacemaker.
- Initial postimplantation recovery was uneventful.
Observation:
- Nine weeks later, the patient experienced collapse with dyspnea, tachycardia, and perspiration.
- Ventricular flutter, requiring defibrillation, occurred during pacemaker testing.
- Electrophysiological testing provoked ventricular tachycardia with torsade de pointes, progressing to ventricular fibrillation.
Findings:
- Extensive workup excluded electrolyte imbalance, digitalis intoxication, and structural heart disease.
- Programmed ventricular stimulation induced sustained ventricular arrhythmias.
- Initial sotalol therapy (160 mg twice daily) was ineffective in suppressing torsade de pointes.
Implications:
- This case highlights a rare but serious complication of pacemaker implantation presenting as ventricular arrhythmias.
- Successful management with escalated sotalol dosage (160 mg three times daily) demonstrates the efficacy of adjusted antiarrhythmic therapy.
- Further investigation into the mechanisms of pacemaker-associated ventricular arrhythmias is warranted.