Electrical alternans of pacemaker spike amplitude: an unusual manifestation of permanent pacemaker generator malfunction.

A case of electrical alternans of pacemaker stimulus amplitude is presented, with constant alternation of large and small amplitude pacemaker spikes without loss of ventricular capture, due to a defect in the oscillator hybrid of a rate programmable Medtronic unit. This represents an unusual electrocardiographic manifestation of pacemaker generator malfunction which, to our knowledge, has not been reported previously.