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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
PubMed
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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.

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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.