Hemodynamic compromise associated with ventriculoatrial conduction following transvenous pacemaker placement.

Ventriculoatrial conduction complicating ventricular pacing in a patient with ischemic heart disease led to severe clinical disability and hemodynamic compromise. Data obtained at cardiac catheterization documented that ventriculoatrial conduction of the patients' paced beats led to inadequate left ventricular filling pressures, pulmonary congestion and depressed cardiac output. This complication of ventricular pacing can be suspected at bedside examination and emphasizes the importance of considering the possible hemodynamic effects of ventricular pacing when long-term pacemaker therapy is contemplated.