These are two strips from a 90 year old patient with a pacemaker. The pacemaker was past end of life and one paced beat can be seen in the top strip. Note the pacemaker was not sensing at this time. The patient's rhythm is complete heart block (note the slight variation in the pr interval which supports this interpretation) The Second strip shows Torsade de Pointe ventricular tachycardia, note the long QT interval >600ms., the polymorphic morphology and the late coupled PVC the induces the run. Replacement of the pacemaker terminated the arrhythmia.