• Katharina Wedler, Árpad Dávid, and Thomas Körber.
• Warnow-Klinik Bützow, Klinik für Innere Medizin.
• Dtsch. Med. Wochenschr. 2020 Feb 1; 145 (4): 249-251.

HistoryThe 75 year old patient was hospitalized because of vertigo, exertional dyspnea and clamminess. Based on ischemic heart disease with sick sinus syndrome a pacemaker was implanted 5.5 years ago. In consequence of non-permanent atrial fibrillation Dronedaron was added to medication 8 months ago.Findings And DiagnosisThe patient presented unstable. The ECG showed a second-degree atrioventricular block with wenckebach periodic and a frequency of 29 bpm. The pacemaker survey showed primary a proper atrial function but ineffective ventricular stimulation.Therapy And CourseAfter initial external pacing the pacemaker was reprogrammed and in this way the ventricle stimulated effectively. Dronedaron was ceased after checking trigger factors and the patient left hospital after 3 days free of complaints. The pacemaker survey 18 days later showed a proper function with stabilized pacing threshold close to the old level.ConclusionsIn patients with dysfunction of a permanent pacemaker an increased pacing threshold should be excluded and if any the current medication needs to be controlled. Caution should be exercised to Dronedaron here.© Georg Thieme Verlag KG Stuttgart · New York.

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