Cardiac arrest caused by a pacemaker check

A 75-year-old man attended a yearly pacemaker check. His VVIR device was inserted in 2008 for atrial fibrillation with a slow ventricular rate. He subsequently developed ischaemic cardiomyopathy, severely impaired left ventricular (LV) function and underwent tissue aortic valve replacement in 2010. During the pacemaker check he suffered a cardiac arrest consisting of Torsades-de-Pointes and ventricular fibrillation. Cardiopulmonary resuscitation and a single DC shock restored spontaneous circulation, subsequent examination and bloods were unremarkable. Scrutiny of the pacemaker tracings revealed the cause (figure 1). Figure 1 Ventrictular capture …