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EM@3AM: Pacemaker/AICD Complications

A 69-year-old female presents with shortness of breath, orthopnea, and lower extremity swelling. She has a pacemaker placed 3 years ago for a complete heart block. She hands you her pacemaker identification card indicating that she has a single chamber pacemaker. Triage EKG: ventricular pacing spikes followed by QRS complexes. She has crackles at the lung bases and 2+ lower extremity pitting edema. What is the diagnosis? What is your next step in evaluation? What are some the types of pacemaker complications you should be evaluating for?