An overlooked case of pacemaker-related heart failure

This case describes an iatrogenic cause of heart failure: the pacemaker syndrome. The diagnosis was initially overlooked but in retrospect could have easily been made by reviewing the rhythm strip recorded during the echocardiogram. The patient eventually received the correct treatment to restore atrioventricular synchrony and experienced rapid resolution to her disabling symptoms. LEARNING POINTS: New-onset heart failure following a pacemaker implant should be evaluated with an echocardiogram. Alongside pacing-induced left ventricular systolic dysfunction and pacing wire-related cardiac valve disruption, pacemaker syndrome should be considered. Interpreting a good-quality (showing both P waves and QRS complexes) rhythm strip can greatly aid in the diagnosis of pacemaker syndrome.