Cas du mois Août 2020 -Rythmologie-

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50 years old male without cardiovascular risk factors 
Pace maker in March 2015 for a paroxysmal complete atrioventricular block (AVB) with syncope (PM DDD SJM ENDURITY DR)
Presented to emergency for ferquent palpitations and dyspnea   
ECG : alternance between tachycardia 150 bpm and normal rythm 
Image : Pacemaker telemetry 
 

 


 










The palpitations are due to ?





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