Pacemaker - Mediated tachycardia leading to ventricular tachycardia and syncope

An 84-year-old patient with St Jude Medical Endurity TM 2140 DDDR PPM presented with episodes of palpitations and syncope of 1-month duration. In the hospital, he was detected to have PMT. The tachycardia was initiated by a prolonged AV delay due to active VIP TM algorithm. The pacemaker EGMs at the time of syncope showed that the PMT was followed by a fast VT. The VT terminated spontaneously. The VIP TM algorithm was made inactive and the PVARP was increased from 275 ms to 350 ms. He has had no further episodes of PMT or VT over a 15-month period.