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Vol. 69. Issue 7.
Pages 697 (July 2016)
ECG Contest
DOI: 10.1016/j.rec.2016.03.022
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ECG, July 2016
ECG de julio de 2016
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Pablo Elpidio García-Granja
Corresponding author
pabloelpidio88@gmail.com

Corresponding author:
, Elvis J. Amao Ruiz, Emilio García-Morán
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Rev Esp Cardiol. 2016;69:78410.1016/j.rec.2016.03.023
Pablo Elpidio García-Granja, Elvis J. Amao Ruiz, Emilio García-Morán
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We report the case of an 86-year-old woman who presented to the emergency department with syncope and spasms in left upper extremity. She had recently undergone implantation of a dual-chamber pacemaker because of symptomatic, paroxysmal, complete atrioventricular block secondary to syncope. Figure 1 shows the electrocardiogram on her arrival at the emergency room and Figure 2, the chest radiograph.

Figure 1
(0.58MB).
Figure 2
(0.05MB).

Which diagnosis is most probable?

  • 1.

    Loss of ventricular capture and loss of atrial sensing and capture due to ratchet syndrome.

  • 2.

    Loss of ventricular capture and loss of atrial sensing and capture due to twiddler syndrome.

  • 3.

    Loss of ventricular capture and loss of atrial sensing and capture due to reel syndrome.

  • 4.

    Loss of ventricular capture due to probable ionic remodeling. Atrial lead not implanted.

Suggest a solution to this ECG contest at http://www.revespcardiol.org/es/electroreto/69/07 #RetoECG (only Spanish). The answer will be published in the next issue (August 2016).

Copyright © 2016. Sociedad Española de Cardiología
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