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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL2Fuc3dlcnMvMTYyMjQ1LTExMTgyNS84OTI3NDgtb3ZlcnZpZXc=\nDrugs & Diseases > Cardiology > Pacemakers and Implantable Cardioverter-Defibrillators Q&A\nWhat are subacute complications of implantable cardioverter-defibrillator (ICD) therapy?\nAuthor: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD more...\nSubacute ICD complications include the following:\nPocket hematoma\nWound dehiscence\nLead dislodgment\nDeep venous thrombosis\nUpper extremity edema\nDegradation of lead function\n[Guideline] Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008 May 27. 51(21):e1-62. [Medline].\nKamphuis HC, de Leeuw JR, Derksen R, Hauer RN, Winnubst JA. Implantable cardioverter defibrillator recipients: quality of life in recipients with and without ICD shock delivery: a prospective study. Europace. 2003 Oct. 5(4):381-9. [Medline].\nMirowski M, Reid PR, Mower MM, et al. Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med. 1980 Aug 7. 303(6):322-4. [Medline].\nRobinson LA, Windle JR, Easley AR. Options in managing the patient with high defibrillation thresholds. Ann Thorac Surg. 1994 May. 57(5):1184-92. [Medline].\nBardy GH, Poole JE, Kudenchuk PJ, et al. A prospective randomized comparison in humans of biphasic waveform 60-microF and 120-microF capacitance pulses using a unipolar defibrillation system. Circulation. 1995 Jan 1. 91(1):91-5. [Medline].\nKroll MW, Swerdlow CD. Optimizing defibrillation waveforms for ICDs. J Interv Card Electrophysiol. 2007 Apr. 18(3):247-63. [Medline].\nU.S. Food and Drug Administration. FDA approves first subcutaneous heart defibrillator. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm321755.htm. Accessed: September 28, 2012.\nWever EF, Hauer RN, van Capelle FL, et al. Randomized study of implantable defibrillator as first-choice therapy versus conventional strategy in postinfarct sudden death survivors. Circulation. 1995 Apr 15. 91(8):2195-203. [Medline].\nThe Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med. 1997 Nov 27. 337(22):1576-83. [Medline].\nConnolly SJ, Gent M, Roberts RS, et al. Canadian implantable defibrillator study (CIDS) : a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation. 2000 Mar 21. 101(11):1297-302. [Medline].\nBokhari F, Newman D, Greene M, Korley V, Mangat I, Dorian P. Long-term comparison of the implantable cardioverter defibrillator versus amiodarone: eleven-year follow-up of a subset of patients in the Canadian Implantable Defibrillator Study (CIDS). Circulation. 2004 Jul 13. 110(2):112-6. [Medline].\nKuck KH, Cappato R, Siebels J, Rüppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH). Circulation. 2000 Aug 15. 102(7):748-54. [Medline].\nSiebels J, Kuck KH. Implantable cardioverter defibrillator compared with antiarrhythmic drug treatment in cardiac arrest survivors (the Cardiac Arrest Study Hamburg). Am Heart J. 1994 Apr. 127(4 Pt 2):1139-44. [Medline].\nMoss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial (MADIT) Investigators. N Engl J Med. 1996 Dec 26. 335(26):1933-40. [Medline].\nBuxton AE, Lee KL, Fisher JD, et al. A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial (MUSTT) Investigators. N Engl J Med. 1999 Dec 16. 341(25):1882-90. [Medline].\nBuxton AE, Lee KL, Hafley GE, et al. Relation of ejection fraction and inducible ventricular tachycardia to mode of death in patients with coronary artery disease: an analysis of patients enrolled in the multicenter unsustained tachycardia trial. Circulation. 2002 Nov 5. 106(19):2466-72. [Medline].\nFisher JD, Buxton AE, Lee KL, et al. Designation and distribution of events in the Multicenter UnSustained Tachycardia Trial (MUSTT). Am J Cardiol. 2007 Jul 1. 100(1):76-83. [Medline].\nMoss AJ, Zareba W, Hall WJ. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction (MADIT II). N Engl J Med. 2002 Mar 21. 346(12):877-83. [Medline].\nZwanziger J, Hall WJ, Dick AW, et al. The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. J Am Coll Cardiol. 2006 Jun 6. 47(11):2310-8. [Medline]. [Full Text].\nBristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004 May 20. 350(21):2140-50. [Medline].\nBardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005 Jan 20. 352(3):225-37. [Medline].\nAdabag S, Roukoz H, Anand IS, Moss AJ. Cardiac resynchronization therapy in patients with minimal heart failure a systematic review and meta-analysis. J Am Coll Cardiol. 2011 Aug 23. 58(9):935-41. [Medline].\nLevy WC, Lee KL, Hellkamp AS, et al. Maximizing survival benefit with primary prevention implantable cardioverter-defibrillator therapy in a heart failure population. Circulation. 2009 Sep 8. 120(10):835-42. [Medline]. [Full Text].\nSantangeli P, Pelargonio G, Russo AD, et al. Gender differences in clinical outcome and primary prevention defibrillator benefit in patients with severe left ventricular dysfunction: A systematic review and meta-analysis. Heart Rhythm. 2010 Jul. 7(7):876-82. [Medline].\nKadish A, Dyer A, Daubert JP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 2004 May 20. 350(21):2151-8. [Medline].\nBansch D, Antz M, Boczor S, et al. Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT). Circulation. 2002 Mar 26. 105(12):1453-8. [Medline]. [Full Text].\nBigger JT Jr. Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery. Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. N Engl J Med. 1997 Nov 27. 337(22):1569-75. [Medline]. [Full Text].\nHohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med. 2004 Dec 9. 351(24):2481-8. [Medline].\nStrickberger SA, Hummel JD, Bartlett TG, et al. Amiodarone versus implantable cardioverter-defibrillator:randomized trial in patients with nonischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia--AMIOVIRT. J Am Coll Cardiol. 2003 May 21. 41(10):1707-12. [Medline].\nBarsheshet A, Moss AJ, Eldar M, et al. Time-dependent benefit of preventive cardiac resynchronization therapy after myocardial infarction. Eur Heart J. 2011 Jul. 32(13):1614-21. [Medline].\nPouleur AC, Barkoudah E, Uno H, et al. Pathogenesis of sudden unexpected death in a clinical trial of patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. Circulation. 2010 Aug 10. 122(6):597-602. [Medline]. [Full Text].\nSantangeli P, Di Biase L, Dello Russo A, et al. Meta-analysis: age and effectiveness of prophylactic implantable cardioverter-defibrillators. Ann Intern Med. 2010 Nov 2. 153(9):592-9. [Medline].\nHealey JS, Hallstrom AP, Kuck KH, et al. Role of the implantable defibrillator among elderly patients with a history of life-threatening ventricular arrhythmias. Eur Heart J. 2007 Jul. 28(14):1746-9. [Medline].\nWilcox JE, Fonarow GC, Zhang Y, et al. Clinical effectiveness of cardiac resynchronization and implantable cardioverter-defibrillator therapy in men and women with heart failure: findings from IMPROVE HF. Circ Heart Fail. 2014 Jan. 7(1):146-53. [Medline]. [Full Text].\nPokorney SD, Hellkamp AS, Yancy CW, et al. Primary prevention implantable cardioverter-defibrillators in older racial and ethnic minority patients. Circ Arrhythm Electrophysiol. 2015 Feb. 8(1):145-51. [Medline]. [Full Text].\nErkapic D, Sperzel J, Stiller S, et al, for the INSURE Investigators. Long-term benefit of implantable cardioverter/defibrillator therapy after elective device replacement: results of the INcidence free SUrvival after ICD REplacement (INSURE) trial--a prospective multicentre study. Eur Heart J. 2013 Jan. 34(2):130-7. [Medline].\nZareba W, Moss AJ, Daubert JP, et al. Implantable cardioverter defibrillator in high-risk long QT syndrome patients. J Cardiovasc Electrophysiol. 2003 Apr. 14(4):337-41. [Medline].\nViskin S. Implantable cardioverter defibrillator in high-risk long QT syndrome patients. J Cardiovasc Electrophysiol. 2003 Oct. 14(10):1130-1; reply 1131. [Medline].\nGoel AK, Berger S, Pelech A, et al. Implantable cardioverter defibrillator therapy in children with long QT syndrome. Pediatr Cardiol. 2004 Jul-Aug. 25(4):370-8. [Medline].\nMonnig G, Kobe J, Loher A, et al. Implantable cardioverter-defibrillator therapy in patients with congenital long-QT syndrome: a long-term follow-up. Heart Rhythm. 2005 May. 2(5):497-504. [Medline].\nGoldenberg I, Mathew J, Moss AJ, et al. Corrected QT variability in serial electrocardiograms in long QT syndrome: the importance of the maximum corrected QT for risk stratification. J Am Coll Cardiol. 2006 Sep 5. 48(5):1047-52. [Medline].\nHobbs JB, Peterson DR, Moss AJ, et al. Risk of aborted cardiac arrest or sudden cardiac death during adolescence in the long-QT syndrome. JAMA. 2006 Sep 13. 296(10):1249-54. [Medline].\nGhanbari H, Phard WS, Al-Ameri H, et al. Meta-analysis of safety and efficacy of uninterrupted warfarin compared to heparin-based bridging therapy during implantation of cardiac rhythm devices. Am J Cardiol. 2012 Nov 15. 110(10):1482-8. [Medline].\nBernstein AD, Daubert JC, Fletcher RD, et al. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. Pacing Clin Electrophysiol. 2002 Feb. 25(2):260-4. [Medline].\nMcMullan J, Valento M, Attari M, Venkat A. Care of the pacemaker/implantable cardioverter defibrillator patient in the ED. Am J Emerg Med. 2007 Sep. 25(7):812-22. [Medline].\nLampert R, Hayes DL, Annas GJ, et al. HRS expert consensus statement on the management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm. 2010 Jul. 7(7):1008-26. [Medline].\nFreeman JV, Wang Y, Curtis JP, Heidenreich PA, Hlatky MA. Physician procedure volume and complications of cardioverter-defibrillator implantation. Circulation. 2012 Jan 3. 125(1):57-64. [Medline].\nUslan DZ, Gleva MJ, Warren DK, et al. Cardiovascular implantable electronic device replacement infections and prevention: results from the REPLACE Registry. Pacing Clin Electrophysiol. 2012 Jan. 35(1):81-7. [Medline].\nCurtis JP, Luebbert JJ, Wang Y, et al. Association of physician certification and outcomes among patients receiving an implantable cardioverter-defibrillator. JAMA. 2009 Apr 22. 301(16):1661-70. [Medline].\nFischer A, Ousdigian KT, Johnson JW, Gillberg JM, Wilkoff BL. The impact of atrial fibrillation with rapid ventricular rates and device programming on shocks in 106,513 ICD and CRT-D patients. Heart Rhythm. 2012 Jan. 9(1):24-31. [Medline].\nDaubert JP, Zareba W, Cannom DS, et al. Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol. 2008 Apr 8. 51(14):1357-65. [Medline].\nBhavnani SP, Coleman CI, White CM, et al. Association between statin therapy and reductions in atrial fibrillation or flutter and inappropriate shock therapy. Europace. 2008 Jul. 10(7):854-9. [Medline].\nAlmendral J, Arribas F, Wolpert C, et al. Dual-chamber defibrillators reduce clinically significant adverse events compared with single-chamber devices: results from the DATAS (Dual chamber and Atrial Tachyarrhythmias Adverse events Study) trial. Europace. 2008 May. 10(5):528-35. [Medline].\nHauser RG, Kallinen LM, Almquist AK, et al. Early failure of a small-diameter high-voltage implantable cardioverter-defibrillator lead. Heart Rhythm. 2007 Jul. 4(7):892-6. [Medline]. [Full Text].\nKallinen LM, Hauser RG, Lee KW, et al. Failure of impedance monitoring to prevent adverse clinical events caused by fracture of a recalled high-voltage implantable cardioverter-defibrillator lead. Heart Rhythm. 2008 Jun. 5(6):775-9. [Medline].\nKrahn AD, Champagne J, Healey JS, et al. Outcome of the Fidelis implantable cardioverter-defibrillator lead advisory: a report from the Canadian Heart Rhythm Society Device Advisory Committee. Heart Rhythm. 2008 May. 5(5):639-42. [Medline].\nFaulknier BA, Traub DM, Aktas MK, et al. Time-dependent risk of Fidelis lead failure. Am J Cardiol. 2010 Jan 1. 105(1):95-9. [Medline].\nKallinen LM, Hauser RG, Tang C, et al. Lead integrity alert algorithm decreases inappropriate shocks in patients who have Sprint Fidelis pace-sense conductor fractures. Heart Rhythm. 2010 Aug. 7(8):1048-55. [Medline].\nSwerdlow CD, Sachanandani H, Gunderson BD, et al. Preventing overdiagnosis of implantable cardioverter-defibrillator lead fractures using device diagnostics. J Am Coll Cardiol. 2011 Jun 7. 57(23):2330-9. [Medline].\nMaytin M, Love CJ, Fischer A, et al. Multicenter experience with extraction of the Sprint Fidelis implantable cardioverter-defibrillator lead. J Am Coll Cardiol. 2010 Aug 17. 56(8):646-50. [Medline].\nMorrison TB, Friedman PA, Kallinen LM, et al. Impact of implanted recalled Sprint Fidelis lead on patient mortality. J Am Coll Cardiol. 2011 Jul 12. 58(3):278-83. [Medline]. [Full Text].\nUS Food & Drug Administration. Premature insulation failure in recalled Riata implantable cardioverter defibrillator (ICD) leads manufactured by St. Jude Medical, Inc.: FDA safety communication [archived]. Available at http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm314930.htm. January 12, 2015; Accessed: February 13, 2017.\nHaines DE, Wang Y, Curtis J. Implantable cardioverter-defibrillator registry risk score models for acute procedural complications or death after implantable cardioverter-defibrillator implantation. Circulation. 2011 May 17. 123(19):2069-76. [Medline].\nThaker JP, Patel MB, Jongnarangsin K, Liepa VV, Thakur RK. Electromagnetic interference with pacemakers caused by portable media players. Heart Rhythm. 2008 Apr. 5(4):538-44. [Medline].\nMedtronic. Electromagnetic Compatibility Guide. Medtronic. Available at http://www.medtronic.com/rhythms/downloads/UC200602918EN.pdf.\nPavia S, Wilkoff B. The management of surgical complications of pacemaker and implantable cardioverter-defibrillators. Curr Opin Cardiol. 2001 Jan. 16(1):66-71. [Medline].\nJohnson K. MRI safe in patients with subcutaneous defibrillators. Medscape Medical News. March 11, 2014. Available at http://www.medscape.com/viewarticle/821808. Accessed: March 17, 2014.\nSchukro C, Puchner SB. Safety and efficiency of low-field magnetic resonance imaging in patients with cardiac rhythm management devices. Eur J Radiol. 2019 Sep. 118:96-100. [Medline].\nRashid S, Rapacchi S, Vaseghi M, et al. Improved late gadolinium enhancement MR imaging for patients with implanted cardiac devices. Radiology. 2014 Jan. 270(1):269-74. [Medline]. [Full Text].\nJilek C, Tzeis S, Vrazic H, et al. Safety of screening procedures with hand-held metal detectors among patients with implanted cardiac rhythm devices: a cross-sectional analysis. Ann Intern Med. 2011 Nov 1. 155(9):587-92. [Medline].\nPRNewswire. Boston Scientific announces FDA approval of innovative new defibrillators and heart failure devices [news release]. Boston Scientific. Available at http://news.bostonscientific.com/2014-04-15-Boston-Scientific-Announces-FDA-Approval-Of-Innovative-New-Defibrillators-And-Heart-Failure-Devices. April 15, 2014; Accessed: April 27, 2014.\nBardy GH, Smith WM, Hood MA, et al. An entirely subcutaneous implantable cardioverter-defibrillator. N Engl J Med. 2010 Jul 1. 363(1):36-44. [Medline]. [Full Text].\nBuxton AE, Lee KL, DiCarlo L, et al. Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med. 2000 Jun 29. 342(26):1937-45. [Medline].\n[Guideline] Gregoratos G, Abrams J, Epstein AE, et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee). Circulation. 2002 Oct 15. 106(16):2145-61. [Medline]. [Full Text].\n[Guideline] Gregoratos G, Cheitlin MD, Conill A, et al. ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). J Am Coll Cardiol. 1998 Apr. 31(5):1175-209. [Medline].\nMirowski M. The automatic implantable cardioverter-defibrillator: an overview. J Am Coll Cardiol. 1985 Aug. 6(2):461-6. [Medline].\nMyerburg RJ. Implantable cardioverter-defibrillators after myocardial infarction. N Engl J Med. 2008 Nov 20. 359(21):2245-53. [Medline].\nScott PA, Silberbauer J, McDonagh TA, Murgatroyd FD. Impact of prolonged implantable cardioverter-defibrillator arrhythmia detection times on outcomes: a meta-analysis. Heart Rhythm. 2014 May. 11(5):828-35. [Medline].\nStiles S. Cutting inappropriate ICD shocks: Long arrhythmia-detection time strategy confirmed. Heartwire from Medscape. February 21, 2014. Available at http://www.medscape.com/viewarticle/820918. Accessed: March 17, 2014.\nWinkle RA, Mead RH, Ruder MA, et al. Long-term outcome with the automatic implantable cardioverter-defibrillator. J Am Coll Cardiol. 1989 May. 13(6):1353-61. [Medline]. [Full Text].\nUS Food and Drug Administration. FDA approves first leadless pacemaker to treat heart rhythm disorders [news release]. April 6, 2016. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm494417.htm. Accessed: June 2, 2016.\nMaeda R, Minami Y, Haruki S, et al. Implantable cardioverter defibrillator therapy and sudden death risk stratification in hypertrophic cardiomyopathy patients with midventricular obstruction: A single-center experience. Int J Cardiol. 2016 Jul 1. 214:419-22. [Medline].\nMigliore F, Silvano M, Zorzi A, et al. Implantable cardioverter defibrillator therapy in young patients with cardiomyopathies and channelopathies: a single Italian centre experience. J Cardiovasc Med (Hagerstown). 2016 Jul. 17(7):485-93. [Medline].\nHikage T, Nojima T, Fujimoto H. Active implantable medical device EMI assessment for wireless power transfer operating in LF and HF bands. Phys Med Biol. 2016 Jun 21. 61(12):4522-36. [Medline].\nHayashi Y, Takagi M, Kakihara J, et al. Safety and efficacy of high-rate cutoff and long detection interval ICD programming in secondary prevention patients. Heart Vessels. 2017 Feb. 32(2):175-85. [Medline].\nMaurizi N, Tanini I, Olivotto I, et al. Effectiveness of subcutaneous implantable cardioverter-defibrillator testing in patients with hypertrophic cardiomyopathy. Int J Cardiol. 2017 Mar 15. 231:115-9. [Medline].\nYounes A, Al-Kindi SG, Alajaji W, Mackall JA, Oliveira GH. Presence of implantable cardioverter-defibrillators and wait-list mortality of patients supported with left ventricular assist devices as bridge to heart transplantation. Int J Cardiol. 2017 Mar 15. 231:211-5. [Medline].\nGiammaria M, Cerrato E, Imazio M, Curnis A. Active implanted cardiac devices and magnetic resonance: results of a survey among cardiologists of Piedmont. J Cardiovasc Med (Hagerstown). 2017 Mar. 18(3):185-95. [Medline].\nIp JE, Wu MS, Kennel PJ, et al. Eligibility of pacemaker patients for subcutaneous implantable cardioverter defibrillators. J Cardiovasc Electrophysiol. 2017 May. 28(5):544-8. [Medline].\nFarid TA, Omer MA, Gosch K, et al. Stability of pacing indices and need for pacing in cardiac transplant patients over 1 year of follow-up. J Interv Card Electrophysiol. 2017 Jun. 49(1):27-32. [Medline].\nPadmanabhan D, Kella DK, Deshmukh AJ, et al. Safety of thoracic magnetic resonance imaging for patients with pacemakers and defibrillators. Heart Rhythm. 2019 May 29. [Medline].\nThird-degree heart block. Image courtesy of James Heilman, MD, via Wikimedia Commons.\nElectrocardiogram showing complete heart block. The ventricular rate is 25 per minute, the QRS complex is very wide, and there is atrioventricular dissociation. Image courtesy of Case Reports in Cardiology ((Jafar NS, et al. Rapidly Progressive Atrioventricular Block in a Patient with Sarcoidosis. Case Rep Cardiol. 21 Aug 2014; Article ID 372936).\nComplete heart block. Likely a Mobitz II block with sequential blocked P waves.\nIntermittent periods of ventricular capture.\n100% ventricular paced rhythm.\nDaniel M Beyerbach, MD, PhD Medical Director, Cardiac Rhythm Program, The Christ Hospital; Affiliate Clinical Assistant Professor of Biomedical Science, Florida Atlantic University\nDaniel M Beyerbach, MD, PhD is a member of the following medical societies: American College of Cardiology\nJeffrey N Rottman, MD Professor of Medicine, Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine; Cardiologist/Electrophysiologist, University of Maryland Medical System and VA Maryland Health Care System\nJeffrey N Rottman, MD is a member of the following medical societies: American Heart Association, Heart Rhythm Society\nLawrence C Brilliant, MD Clinical Assistant Professor, Department of Primary Care and Community Services, MCP Hahnemann University; Attending Physician, Department of Emergency Medicine, Doylestown Hospital\nDavid FM Brown, MD Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital\nDavid FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine\nNimarpreet Gill-Saraon Medical University of Silesia, Katowice, Poland\nNimarpreet Gill-Saraon is a member of the following medical societies: American Medical Student Association/Foundation\nRobert Allen Hessler, PhD, MD, FACEP Associate Professor of Emergency Services, New York University School of Medicine; Assistant Director, Department of Emergency Services, Bellevue Hospital Center and New York University Medical Center\nA Antoine Kazzi, MD Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon\nA Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine\nJames Li, MD Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine\nAndrew C Miller, MD Fellow, Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center (UPMC); Attending Physician, Department of Emergency Medicine, UPMC St Margaret's Hospital\nAndrew C Miller, MD is a member of the following medical societies: American Medical Association\nBrian Olshansky, MD Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine\nBrian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences\nDisclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting\nJustin D Pearlman, MD, ME, PhD, FACC, MA Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Director of Cardiology Quality Program KMC, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School\nJustin D Pearlman, MD, ME, PhD, FACC, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America\nTajinderpal S Saraon, MD Cardiology Fellow, Department of Cardiovascular Disease, State University of New York Downstate Medical Center\nRichard H Sinert, DO Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center\nRichard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine\nMaria Vasilyadis, MD Staff Physician, Department of Emergency Medicine, New York University Medical Center\nBarry M Weinberger, DO Assistant Professor, Department of Cardiology, Temple University Hospital"