A case of cardiogenic shock due to ventricular dyssynchrony resolved by atrial pacing

We present a case of a man with ischemic cardiomyopathy and single chamber implantable cardioverter-defibrillator who developed sinus arrest creating sudden dependence on right ventricular (RV) pacing. He presented with cardiogenic shock secondary to abrupt onset ventricular dyssynchrony from RV pacing, which required emergent stabilization and completely resolved with atrial pacing. Learning objective To establish a basic understanding of cardiogenic shock management. To reinforce the adverse effects associated with right ventricular pacing.