Key result
Sudden bradycardia due to a change in pacemaker programming can cause QT prolongation and polymorphic ventricular tachycardia, necessitating a lower pacing rate of 70-90 bpm initially.
Case Report
When changing pacemaker modes, programming a lower pacing rate of 70-90 bpm for the first 3 months is crucial to prevent sudden bradycardia-induced QT prolongation and polymorphic ventricular tachycardia.
Case suggests monitoring QT after pacemaker reprogramming; leaves open whether initial rates of 70-90 bpm prevent polymorphic VT.
Key Teaching Points•Bradycardia is an important cause of QT prolongation and polymorphic ventricular tachycardia.•A VDD pacemaker has a single ventricular lead with an atrial sensor; it senses the atrium and paces the ventricle to maintain atrioventricular synchrony. A VVI pacemaker has a single ventricular lead with no atrial sensor; it only paces the ventricle.•It is important to program pacemakers to a lower pacing rate of 70–90 beats per minute, particularly in the first 3 months after a change in pacing mode that could create sudden bradycardia. •Bradycardia is an important cause of QT prolongation and polymorphic ventricular tachycardia.•A VDD pacemaker has a single ventricular lead with an atrial sensor; it senses the atrium and paces the ventricle to maintain atrioventricular synchrony. A VVI pacemaker has a single ventricular lead with no atrial sensor; it only paces the ventricle.•It is important to program pacemakers to a lower pacing rate of 70–90 beats per minute, particularly in the first 3 months after a change in pacing mode that could create sudden bradycardia.
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Elsokkari et al. (2017) conducted a case report in Polymorphic ventricular tachycardia. Change in pacemaker programming was evaluated. Sudden bradycardia due to a change in pacemaker programming can cause QT prolongation and polymorphic ventricular tachycardia, necessitating a lower pacing rate of 70-90 bpm initially.
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