Dual chamber pacemaker with failure to sense and pace of V lead.
Given the timing of 1wk after implantation, lead dislodgement is most likely.
s/p VVI 10years+
Single chamber pacemaker with failure to sense and pace of V lead.
Given the timing of 10years after implantation, lead fracture, insulation break, or
battery depletion are possible. In this case, lead impedance was 1800 Ohm, so lead fracture
was the cause.
DDD 60/120 AVD 170.
A and V leads switch in the header. Ventricular pacing is being inhibited by P wave (middle tracing),
ruling out lead dislodgement (there needs to be a lead in atrium).
Inhibition of V pacing is intermittent due to higher sensitivity in A channel.
50F with complete heart block s/p DDD 8 years ago, presents with syncope.
Pacemaker parameters are within normal ranges. Holter recording is as shown.
Intermittent failure to pace the ventricle is noted. Oversensing is suspected.
Normal pacemaker function. DDI 60, AVD 200.
Normal pacemaker function. Rhythm = sinus rhythm with AV Wenckebach.
V pacing came on the dropped beats.
Pacemaker mediated tachycardia; triggered by a PVC with retrograde P, followed
by an non-capture A pacing with long AV delay, allowing the following retrograde
VA conduction to capture the atrium and initiate PMT.
Sinus tachycardia with pacemaker Wenckebach.
TARP = 200+120, UTR = 110 bpm = 546 ms, 2:1 block @ 320 ms or 188 bpm,
WKB 320-546 ms or 188 to 110 bpm.
Safety pacing triggered by timely PVCs. Noted with short AV delays.
Managed ventricular pacing: AAI mode switches to DDD with short AV delay after
AP without native ventricular beat.
CRT non-responder. What is the next appropriate management?
Atrial flutter with intermittent biventricular pacing. Noted with beats of fusion
and native LBBB.
65M s/p CRT, in ICU with pneumonia and respiratory failure. The device is programmed
DDDR, 60-125 bpm.
The most likely explanation for the below tracing is:
Sinus tachycardia above upper rate limit; hence no biventricular pacing.
1hr after DDD implantation.
The atrial lead has dislodged into the ventricle. Ventricular captures are seen
by the first spike (from atrial lead) followed by a functional non-capture from the second spike (from
1wk post CRT
Normal CRT function with VV delay of 40ms.
VVIR; post chest radiation
Pacemaker failure. Radiation may cause deterioration of lead and pacemaker
circuit. ECG show asynchronous pacing. Urgent generator change is needed.
Atrial undersensing. Some of A pacing spikes occur at the time of native QRS causing