Publish in this journal
Journal Information
Vol. 70. Issue 6.
Pages 499 (June 2017)
Download PDF
More article options
Vol. 70. Issue 6.
Pages 499 (June 2017)
ECG Contest
DOI: 10.1016/j.rec.2016.12.006
Full text access
ECG, June 2017
ECG de junio de 2017
Julián Palacios-Rubio
Corresponding author

Corresponding author:
, Virginia Ruiz-Pizarro, Diego Valdivia-Miranda
Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
Related content
Rev Esp Cardiol. 2017;70:59410.1016/j.rec.2016.12.007
Julián Palacios-Rubio, Virginia Ruiz-Pizarro, Diego Valdivia-Miranda
Article information
Full Text
Download PDF
Figures (1)
Full Text

An 80-year-old man attended the clinic with symptoms of heart failure. Eight years earlier, he received a replacement DDDR pacemaker for Mobitz II atrioventricular (AV) block (lower rate limit, 60; upper tracking rate, 120; sensor rate, 120; automatic mode switching 160; AV delay, sensed 150ms and paced 180ms; bipolar sensing, monopolar stimulation). An electrocardiogram was recorded (Figure).


What do you think was the most likely diagnosis?

  • 1.

    The patient had circus movement tachycardia (ventricular pacing at the upper rate limit)

  • 2.

    The patient had atrial fibrillation poorly sensed by the device and mode switching has not occurred.

  • 3.

    The patient had a dysfunctional device with defective sensing and capture and chaotic pacing via the atrial and ventricular channels.

  • 4.

    The patient had sinus tachycardia secondary to heart failure, tracked by the pacemaker but with defective atrial sensing.

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

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

Subscribe to our newsletter

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?