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Vol. 70. Issue 8.
Pages 667 (August 2017)
ECG Contest
DOI: 10.1016/j.rec.2017.01.018
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ECG, August 2017
ECG de agosto de 2017
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Javier Higueras
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javierhnb@yahoo.es

Corresponding author:
, Julián Palacios-Rubio, Carmen Olmos
Instituto Cardiovascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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Rev Esp Cardiol. 2017;70:77410.1016/j.rec.2017.01.019
Javier Higueras, Julián Palacios-Rubio, Carmen Olmos
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The patient was 76 years old with recurrent vasovagal syncope and a mixed positive tilt table test. An AAIR<->DDDR mode pacemaker was implanted with minimum and maximum rates of 60 and 130 bpm, respectively, and an atrioventricular pacing interval of 150ms, with a managed ventricular pacing algorithm. After implantation, the patient had felt well for a while but returned to the clinic with a new episode of syncope. The Holter trace is shown in the Figure.

Figure
(0.79MB).

What is the diagnosis and what is the most appropriate approach?

  • 1.

    The syncope is related to failure of ventricular capture because the pacemaker lead has moved. The patient should be admitted immediately to hospital.

  • 2.

    The syncope is probably unrelated, failure of ventricular capture has occurred, and the patient should be examined.

  • 3.

    The syncope is probably unrelated, failure of atrial capture has occurred, and the patient should be examined.

  • 4.

    The pacemaker is working correctly.

Suggest a diagnosis to this ECG contest at http://www.revespcardiol.org/es/electroreto/70/8. The answer will be published in the next issue (September 2017). #EKGchallenge.

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