Abstract
A patient with sinoatrial node disease is reported who demonstrated inadvertent atrial pacing from a ventricular unipolar myocardial electrode and a VVI Intermedics pacemaker. Atrial refractory and vulnerable periods are addressed in this context as possibly providing the environment for an atrial arrhythmia, secondary to competition between the non-sensed impulse and the unipolar cathodal stimulus falling in the atrial vulnerable period.
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