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A 4-year-old 31.0-kg (68.2-lb) castrated male mixed-breed dog was examined by the cardiology service at the Colorado State University Veterinary Teaching Hospital for a scheduled recheck examination and pacemaker interrogation. Previous diagnoses include bartonellosis; severe, chronic hepatitis; and third-degree (ie, complete) atrioventricular (AV) block. Intermittent atrial standstill attributable to some degree of sinoatrial dysfunction was also present. Two weeks prior to the recheck examination, a pacemaker with transdiaphragmatic epicardial leads had been placed in response to a 3-month history of labored breathing, lethargy, and syncope. Epicardial leads had been selected, rather than transvenous, endocardial leads, because the previously diagnosed