# A Tale of Two “Unexpected” Asystoles

## TL;DR

This paper discusses two cases where patients with heart devices experienced unexpected heart stoppage, highlighting the importance of monitoring and backup pacing.

## Contribution

The paper emphasizes the need to identify patients with conduction disorders who may benefit from backup pacing despite using non-pacing devices.

## Key findings

- Two cases of prolonged asystoles were successfully managed with WCD and subcutaneous ICD.
- Monitoring features of these devices can detect bradyarrhythmias.
- Patients with paroxysmal conduction disorders may require backup pacing.

## Abstract

We report two cases of prolonged “unexpected” asystoles in patients with a wearable cardioverter-defibrillator (WCD) and a subcutaneous implantable cardioverter-defibrillator (ICD), respectively, which were promptly recognized and successfully managed. As these devices are designed to recognize and treat malignant tachyarrhythmias but do not provide pacing capabilities, it is crucial to identify patients with paroxysmal conduction disorders who might require backup pacing. For this reason, it is also important to leverage the monitoring features of both devices and their ability to detect the occurrence of bradyarrhythmias.