The patient is an 81-year-old male whose pacemaker was implanted two years previously at another hospital for “intermittent AV block, bradycardia and paroxysmal atrial fibrillation and flutter.” He presented for evaluation, complaining of marked fatigue and exercise tolerance. He also reported that this had been developing since implantation of his pacemaker. His monitoring physician kept telling him that the pacing system was functioning properly and that he had to accept the fact that he was getting older. He sought a second opinion.
