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  • Title: [Reproducible ventricular flutter during programming of a DDD pacemaker].
    Author: Bienstein B, Grosse-Heitmeyer W, Liebetrau M, Stauff L.
    Journal: Dtsch Med Wochenschr; 1993 Dec 23; 118(51-52):1889-92. PubMed ID: 8287779.
    Abstract:
    A bipolar DDD pacemaker system was implanted in a 51-year-old woman with a 2 degrees (Mobitz type) atrioventricular block. The first postimplantation control was unremarkable, but she collapsed 9 weeks later with dyspnoea, tachycardia and profound perspiration. Ventricular flutter occurred twice during routine ambulatory pacemaker function tests one week later. The first episode was terminated by a precordial blow with a fist, but the second required electrical defibrillation. During the subsequent hospitalization abnormal electrolyte balance and digitalis intoxication were excluded. Left-heart catheterization with coronary angiography showed normal left-ventricular function at rest and normal coronary arteries. There was no evidence for an arrhythmogenic right ventricle. Electrophysiological testing with programmed ventricular stimulation provoked ventricular tachycardia with torsade de pointes and transition to ventricular fibrillation. Antiarrhythmic treatment with sotalol, 160 mg twice daily by mouth, failed to suppress the episodes of torsade de pointes. But further programmed ventricular stimulation was uneventful after the sotalol dosage had been increased to 160 mg three times daily.
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