Is competition always good? dual pacemaker management pitfalls.

Alternating or variable paced QRS morphologies following pacemaker implantation is an important clinical observation. Patients undergoing pacemaker upgrade where contralateral implantation was performed, old generator usually removed. Some centers prefer either leaving the old device in the body or removal after few weeks due to risk of infection. Leaving old pacemaker in the body might lead to dangerous circumstances such as inhibiting new pacing system in a pacemaker dependent patient. This case highlights the complexities and potential complications of managing dual pacemakers.