[Recurrent ventricular fibrillation after defibrillation in a patient with pacemaker].
METHODS
A 62-year-old patient was admitted for an operation of a hernia of the right groin in the surgical department. He had a dual chamber pacemaker because of a binodal disease. Pre-operatively the patient was reanimated because of ventricular fibrillation in dilated cardiomyopathy and was defibrillated 12 times, unexpectedly often.


METHODS
The reason of the repeated ventricular fibrillation was a spike-on-T-phenomenon due to loss of the sensing function of the pacemaker (entrance bloc).


METHODS
Therefore, the pacemaker was explanted, and the ventricular fibrillation came to an end. The patient recovered.


CONCLUSIONS
The repeated defibrillations with the electrodes over the basis and the apex of the heart damaged the pacemaker. The following fibrillation episodes were founded on a spike-on-T-phenomenon. In order to prevent such damage of pacemakers, pacemaker patients should be defibrillated and cardioverted in anterior-posterior position of the electrodes.
Wilke
A
A
Abteilung Innere Medizin-Schwerpunkt Kardiologie, Klinikum der Philipps-Universität Marburg. wilke3@mailer,uni-marburg.de
Noll
B
B
Maisch
B
B
D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000503:physiopathology; D004554:Electric Countershock / Q000009:adverse effects*; D004562:Electrocardiography; D004868:Equipment Failure; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D055502:Secondary Prevention; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*