Troubleshooting of left ventricular (LV) lead fractures in cardiac resynchronisation therapy patients is important, especially for those with limited and problematic transvenous LV lead placement. In this case, surgical epicardial LV lead implantation was employed.

A 92-year-old small-framed man developed torsade de pointes during pacemaker-generator exchange. His family physician prescribed bepridil 200 mg/day. High bepridil concentration of 1409 ng/mL was revealed. Electrophysiologists at pacemaker clinic should pay attention to arrhythmia management including bepridil concentration when the family physician prescribes bepridil to a pacemaker patient.