Abstract

A 67-year-old man with a DDD pacemaker for complete atrioventricular block had dyspnea with cardiomegaly on a chest radiogram. Additionally, he had atrial fibrillation, which was well controlled with a class Ic antiarrhythmic agent. He had chronic kidney disease; therefore, uremic pericardial effusion was highly suspected, and pericardiostomy was performed. During surgery, the pacemaker mode was temporarily set to DOO to avoid electrical interference. After surgery, dyspnea was relieved, but it recurred 2 days later without aggravated pericardial effusion. An electrocardiogram showed wide QRS tachycardia at 150 beats per minute. What is the mechanism?

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