We fully agree that DVI pacing would be superior to VVI pacing whenever pacing is indicated in a low cardiac output state. The positive contribution of the atrial contraction to the cardiac output ("atrial kick") can, under these circumstances, indeed be beneficial, if not life-saving. In our patient, however, bradycardia occurred only in the first hour after admission, after which AV conduction reverted to normal with a sinus rate of 70/min. Meanwhile her low cardiac output state responded well to volume expansion, which remains one of the mainstays of therapy in right ventricular infarction. We certainly would have considered AV sequential pacing in case of recurrence of the low cardiac output state, despite the above-mentioned therapy.