Patient Z is a 78 year old male with a medical history of ischemic cardiomyopathy who had an implantable cardioverter-defibrillator (ICD) placed earlier in the beginning of 2016 [dual-chamber, rate-modulated (DDDR) pacemaker] , hypertension and hypothyroidism. Patient Z presented to the ER after 1 episode of dizziness, elevated blood pressure to 170 systolic and bradycardia of 40bpm. Symptoms resolved en route to the ER but elevated blood pressure and bradycardia persisted. His ICD [with  lower rate limit set at 60bpm] was interrogated about five months ago. Initial work for acute coronary artery disease and other structural heart disease…