New pacer causing afib?


  • Specializes in cardiac, progressive care.

Hi everyone,

I have not been on this site for quit a while, its good to be back. Yesterday I had a pt that had a pacer AICD placed the day before. At the start of my shift, tele showed the pt 100% paced with occasional PVC. Pacer was checked by interventional staff which stated everything was working fine. Mid afternoon pt rhythm is irregular with HR of 150 to 160 sustained, with few if any paced beats. No CP, dyspnea, dizziness, but pt complains of heart feels like its skipping. BP 130s over 70s. Stat EKG done confirms afib with rvr, gave pt cardizem ivp followed by titrated cardizem gtt. Rythmol po given, as well as lopressor ivp. Took about 3 hours for HR to convert to Sinus with 100% paced beats. Pt received 50 mg toprol XL earlier that day. With all those meds on board why did it take so long for rhythm to convert? Also, is it possible that the placement of the pacer caused irritation to the heart which triggered this rhythm? Pt was SR with occasional couplet PVCs prior to placement.


Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

I don't know if it's possible to say for certain what caused the episode of AF. Does the pt. have any LV hypertrophy, cardiomyopathy, valve disease, or CAD? Is it possible that this person has experienced AF in the past?

Some cases of AF are very resistant to medications, which is why some people undergo ablation or cardioversion. You say it took 3 hours for the person to convert, but what was their rate like during that 3 hours?

Hopefully this person has been started on Coumadin.

Tait, MSN, RN

6 Articles; 2,140 Posts

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 16 years experience.

It is hard to tell, without a patient history for me. I would assume the patient was in afib at some point prior to the pacer, hence the reason for the pacer. Or was the pacer for syncope? Vtach? Brady? When someone is already pacing most of the time it doesn't surprise me that they might convert into afib, considering the electrical system is already compromised.

I would be interested to know if the pacer is capturing, because it sounds like it was working, and then wasn't. Have they interrogated the device yet?

I deal with pacers so often, but everyday they surprise me. I had one patient that had been shocked 28 times in a month, but she never knew it. To me that sounds like the pacer was registering a shock, but maybe wasn't actually administering it, because most patients state the shock to be like a kick to the chest.

That is all I can think of at the moment.


Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

Or the pacer rate was set higher than the RVR.

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