Minute ventilation responsive rate adaptive pacemaker improves exercise performance in the patients with chronotropic insufficiency. The usual complications of these pacemakers are related to pacemaker implantation, rather than to the rate adaptive function.We report a patient with mitral stenosis and atrial fibrillation with a VVIR pacemaker, who was mechanically ventilated for respiratory failure. The patient could not be weaned because of the minute ventilation driven increased heart rates. Subsequently the rate adaptive function was switched off and the patient was successfully weaned from ventilator.Difficulty in weaning from mechanical ventilation can be a serious complication in patients with organic heart disease, who depend on diastolic filling time for adequate cardiac output.
