The article presents a case study of a 81-year-old manwith Medtronic Adapta L pacemaker implanted for symptomatic bradycardia. Topics discussed include elective epidural steroid injection for symptomatic lumbosacral degenerative arthritis, potential adverse consequences of right ventricular (RV) pacing and pacemaker malfunction due to atrial pacing slower than the programmed lower rate limit.