Temperature-related tachycardia during rewarming from hypothermic cardiopulmonary bypass in a patient with a leadless cardiac pacemaker

Berrio Valencia MI*, Kee C, Guo LR, Flier S.
Can J Anaesth. 2018 Feb 27. doi: 10.1007/s12630-018-1100-8. [Epub ahead of print]


We present an interesting a case of a 78-yr-old patient coming for tricuspid valve replacement. He had an indwelling Nanostim leadless pacemaker inserted in the US two years earlier. At the end of cardiopulmonary bypass, during rewarming, the pacemaker rate suddenly increased to 120 bpm preventing discontinuation from bypass. It became apparent that the pacemaker features heart rate modulation based on blood temperature. Electrophysiology was consulted only to discover they did not dispose of the right equipment to reprogram the device. We then used magnets located over the apex of the heart, to switch the leadless pacemaker to fixed mode and used temporary epicardial wires to overpace the leadless pacemaker. Cardiopulmonary bypass could be discontinued and the patient could be transferred to the unit. In the unit, the leadless pacemaker was pacing at a normal rate again, and epicardial pacing was discontinued.


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 Dr. Berrio is a fellow with the Department of Anesthesia and Perioperative Medicine.
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