Pacemaker upgrade for recurrent pacemaker syndrome using a redundant contralateral electrode in a patient with bilateral venous stenoses.

Following His-bundle ablation and VVIR pacemaker implantation, severe Pacemaker syndrome developed and was treated with DDDR pacing in a 70-year-old woman. Due to bilateral subclavian vein stenosis, DDDR pacing could not be maintained and an unusual method of restoring atrioventricular synchrony is described using the contralateral redundant atrial electrode connected to the ipsilateral dual chamber pacemaker and ventricular electrode.