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Vol. 72. Issue 1.
Pages 77 (January 2019)
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Vol. 72. Issue 1.
Pages 77 (January 2019)
ECG Contest
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ECG, January 2019
ECG de enero de 2019
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Pablo Martínez-Vives
Corresponding author
mvpablo@outlook.com

Corresponding author:
, Ana Fernández-Vega, Victoria Cañadas-Godoy
Unidad de Arritmias, Instituto Cardiovascular, Hospital Clínico San Carlos y CIBER de Enfermedades Cardiovasculares, Madrid, Spain
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Rev Esp Cardiol. 2019;72:16610.1016/j.rec.2018.04.031
Pablo Martínez-Vives, Ana Fernández-Vega, Victoria Cañadas-Godoy
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A 70-year-old man with atrial fibrillation who was receiving anticoagulation therapy was admitted to the neurology department after a stroke. During his admission, slow ventricular conduction of the atrial fibrillation was observed, and so a single-chamber pacemaker with unipolar pacing in VVIR mode was implanted.

At 2hours after implantation, episodes of tachyarrhythmia with broad QRS were observed. The ECG shown in the Figure 1 was recorded.

Figure
(0.37MB).

What do you think is the most likely diagnosis?

  • 1.

    The electrode has impacted the apex and is causing abundant edema with capture failure and ventricular ectopy.

  • 2.

    Ventricular ectopy is observed due to mechanical pacing of the electrode, which is loose in the right ventricular outflow tract.

  • 3.

    The increase in circulating catecholamines due to the stroke is causing rapid and aberrant conduction of the underlying atrial fibrillation.

  • 4.

    The patient probably has significant hyperpotassemia due to acute stroke, with capture failures and secondary ventricular tachycardia.

Submit your answer to http://www.revespcardiol.org/en/electroreto/72/01. The solution will be published in the next issue (February 2019). #ECGChallenge #RetoECG..

Copyright © 2018. Sociedad Española de Cardiología
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