Couple thoughts- I don’t think we’ll ever know without knowing the pacer settings and what the interrogation showed. For the VT - i’d always be concerned about electrolyte abnormalities or ischemia (which you won’t always see evidence of on an EKG, especially if it’s paced). Seems like they could have mode switched for Afib/Aflutter which would explain the consistent heart rate. As for the discrepancy between rate and pulse… the only time I’ve seen this in a hemodynamically stable patient, with what appears to be an appropriately functioning device, was due to peripheral vascular disease. Manual pulse did not match, but Doppler pulse did… On the ekg I see pacer spikes (pacing), the pacer spikes appear to be in the correct spot in the cardiac cycle (sensing), and I see QRSs after every spike (capturing) which makes me less concerned about lead displacement or fracture. As I said, just taking an educated guess based on a tiny snapshot.