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Vol. 70. Issue 2.
Pages 119 (February 2017)
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Vol. 70. Issue 2.
Pages 119 (February 2017)
ECG Contest
DOI: 10.1016/j.rec.2016.11.012
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ECG, February 2017
ECG de febrero de 2017
Javier León Jiménez
Corresponding author

Corresponding author:
, Santiago Jesús Camacho Freire, José Raúl López Aguilar
Servicio de Cardiología, Complejo Hospital Juan Ramón Jiménez, Huelva, Spain
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Rev Esp Cardiol. 2017;70:19810.1016/j.rec.2016.11.013
Javier León Jiménez, Santiago Jesús Camacho Freire, Raúl López Aguilar
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A 70-year-old man with a personal history of hypertension, stroke, and single-vessel ischemic heart disease involving the right coronary artery treated with percutaneous placement of a drug-eluting stent, was admitted for syncope, hypotension, and severe bradycardia. A definitive DDD pacemaker was implanted with atrioventricular sensing set to 90ms and atrioventricular pacing set to 140ms.

An electrocardiogram was recorded during a follow-up visit (Figure), when the patient was asymptomatic.


What is the most likely diagnosis?

  • 1.

    Loss of ventricular capture due to lead dislodgement

  • 2.

    Loss of ventricular capture due to pacing of necrotic tissue

  • 3.

    Twiddler syndrome

  • 4.

    Normal pacemaker operation

Suggest a solution to this ECG Contest at The answer will be published in the next issue (March 2017). #ECG Contest.

Copyright © 2016. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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