Systolic Pulmonary and Hepatic Vein Flow Reversal Due to Pacemaker‐Induced Retrograde Ventriculoatrial Conduction

Systolic pulmonary and hepatic vein flow reversals can typically be seen with severe atrioventricular ( AV ) valve regurgitation and during atrial fibrillation ( AF ). We report the case of a 67‐year‐old woman who presented with recent‐onset exertional dyspnea. Her pacemaker was near end‐of‐life and reverted to a VVI mode from the preset DDDR mode. Electrocardiography demonstrated retrograde 1:1 ventriculoatrial ( VA ) conduction and spectral D oppler analysis revealed prominent systolic pulmonary and hepatic vein flow reversals. Symptoms, electrocardiogram ( ECG ) findings, and the spectral D oppler abnormalities resolved completely following a generator replacement and resumption of DDDR pacing.