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Vol. 73. Issue 4.
Pages 327 (April 2020)
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Vol. 73. Issue 4.
Pages 327 (April 2020)
ECG Contest
DOI: 10.1016/j.rec.2019.10.017
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ECG, April 2020
ECG de abril de 2020
Sara Lozano Jiménez
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Corresponding author:
, Jorge Toquero Ramos, Xabier Cía Mendioroz
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Rev Esp Cardiol. 2020;73:40910.1016/j.rec.2019.10.020
Sara Lozano Jiménez, Jorge Toquero Ramos, Xabier Cía Mendioroz
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The patient was a 53-year-old woman with congenital heart disease consisting of partial atrioventricular septal defect, corrected in infancy. In light of severe symptomatic mitral valve regurgitation, the mitral valve was replaced with a mechanical prosthetic valve. During the postoperative period, complete atrioventricular block occurred. As this persisted 6 days after the intervention, it was decided to implant a dual-chamber pacemaker, initially programmed in DDDR mode at a minimum frequency of 60 bpm.

Immediately after implantation, the Arrhythmias Unit was alerted due to a paced rhythm at 45 bpm, with the following ECG recorded (figure 1).

Figure 1

What do you think was the most likely diagnosis?

  • 1.

    T-wave oversensing

  • 2.

    Switch to DDI mode due to detection of atrial tachyarrhythmia

  • 3.

    Wenckebach behavior on exceeding the maximum tracking rate

  • 4.

    Sinus tachycardia with 2:1 ventricular pacing due to atrial sensing during the postventricular atrial refractory period

Submit your answer to The answer will be published in the next issue (May 2020). #RetoECG.

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Revista Española de Cardiología (English Edition)

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