Publish in this journal
Journal Information
Vol. 71. Issue 12.
Pages 1072 (December 2018)
Download PDF
More article options
Vol. 71. Issue 12.
Pages 1072 (December 2018)
ECG Contest
Full text access
ECG, December 2018
ECG de diciembre de 2018
Ana Fernández-Vegaa,
Corresponding author

Corresponding author:
, Daniel Enríquez-Vázqueza, Julián Palacios-Rubiob
a Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
b Unidad de Arritmias, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
Related content
Rev Esp Cardiol. 2019;72:7810.1016/j.rec.2018.05.005
Ana Fernández-Vega, Daniel Enríquez-Vázquez, Julián Palacios-Rubio
Article information
Full Text
Download PDF
Figures (1)
Full Text

A 75-year-old man was referred to the emergency room with symptoms of dizziness and poor pacemaker function after the ECG shown in the Figure was recorded. He had a history of permanent atrial fibrillation (AF) and percutaneous revascularization of ischemic heart disease, with moderate systolic left ventricular dysfunction. For 1 year, he had been a carrier of a Meditronic cardiac resynchronization therapy pacemaker (CRT-P) in VVIR mode for AF with complete atrioventricular block (lower rate limit, 70 bpm; maximum tracking rate, 130 bpm; bipolar sensing and pacing; atrial port plugged for permanent AF).


In view of the ECG (Figure), is this pacemaker malfunctioning?

  • 1.

    The CRT-P device is working appropriately.

  • 2.

    This is a sensing issue. The intracardiac electrogram of the ventricular extrasystole probably has a lower voltage than the programmed sensitivity.

  • 3.

    The CRT-P device does not have sensing defects, although resynchronization should be optimized.

  • 4.

    The CRT-P device is operating after activation of the elective replacement indicator, as it only works with right-sided pacing at the lower rate limit.

Suggest a diagnosis to this ECG Contest at The answer will be published in the next issue (January 2019). #RetoECG.

Copyright © 2018. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

View newsletter history
Article options
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?