We report a 51-year-old man with severe ischemic cardiomyopathy and he
art failure in whom incessant bigeminal ventricular ectopy failed to g
enerate a detectable arterial pressure. This created a mechanical brad
ycardia despite an adequate electrical heart rate. Dual chamber pacing
increased the effective heart rate and allowed discontinuation of an
intraaortic balloon pump from which the patient could not otherwise be
weaned.