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Lack of efficacy: case report A 66-year-old man exhibited lack of efficacy following treatment with atropine and dopamine for complete heart block and a ventricular escape rhythm. The man, who had a history of type 2 diabetes, coronary artery disease and hypertension, presented to the emergency department with fatigue and weakness along with transient episodes of loss of consciousness with tonic-clonic movements. Electrocardiography showed complete heart block and a ventricular escape rhythm at 23 beats per minute. For its management, he received atropine and a dopamine infusion [not all routes stated, dosages not stated]. But these showed null effect. Therefore, pacing pads were applied and transcutaneous pacing was initiated. Nine hours after the transcutaneous pacing, a permanent pacemaker was inserted. After the removal of the temporary pacing pads, he was found to have four full-thickness third-degree burns on his chest wall. Singleton MJ, et al. Third-degree burns caused by transcutaneous pacing for third-degree heart block. HeartRhythm Case Reports 6: 495-498, No. 8, Aug 2020. Available 803500158 from: URL: http://doi.org/10.1016/j.hrcr.2020.05.006

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