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Vol. 71. Issue 12.
Pages 1072 (December 2018)
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Vol. 71. Issue 12.
Pages 1072 (December 2018)
ECG Contest
DOI: 10.1016/j.rec.2018.05.006
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ECG, December 2018
ECG de diciembre de 2018
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Ana Fernández-Vegaa,
Corresponding author
afvega@salud.madrid.org

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
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Rev Esp Cardiol. 2019;72:7810.1016/j.rec.2018.05.005
Ana Fernández-Vega, Daniel Enríquez-Vázquez, Julián Palacios-Rubio
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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).

(0.62MB).

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 http://www.revespcardiol.org/en/electroreto/71/12. The answer will be published in the next issue (January 2019). #RetoECG.

Copyright © 2018. Sociedad Española de Cardiología
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