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Vol. 69. Issue 11.
Pages 1101 (November 2016)
ECG Contest
DOI: 10.1016/j.rec.2016.05.034
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ECG, November 2016
ECG de noviembre de 2016
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Ricardo Salgado Aranda
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ricardosalgadodoc@gmail.com

Corresponding author:
, Francisco Javier García Fernández, Francisco Javier Martín González
Unidad de Arritmias, Hospital Universitario de Burgos, Burgos, Spain
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Rev Esp Cardiol. 2016;69:121810.1016/j.rec.2016.05.035
Ricardo Salgado Aranda, Francisco Javier García Fernández, Francisco Javier Martín González
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An 83-year-old man who had undergone implantation of a DDDR pacemaker (Evia DR-T, Biotronik, Berlin, Germany) due to paroxysmal atrioventricular block, had a routine electrocardiogram (Figure 1), that revealed sinus rhythm with premature ventricular contractions in bigeminy and pacemaker spikes superimposed on the QRS of the sinus beats. As a malfunction of the device was suspected, it was subjected to interrogation. All the parameters were normal (atrium/ventricle: P/R wave sensing, 2.3/13mV; impedance, 236/634 Ω, and threshold, 0.3/0.7V at 0.4ms). Figure 2 shows a tracing obtained with the programmer.

Figure 1
(0.42MB).
Figure 2
(0.46MB).

In view of these values, is this a case of a real pacemaker malfunction?

  • 1.

    If the pacing and sensing parameters are normal, there is no malfunction.

  • 2.

    The pacemaker is functioning perfectly. This is a case of fusion: pacing by the device and the appearance of the conducted QRS occur simultaneously.

  • 3.

    Despite the fact that the R wave measured during the interrogation was normal, there is a defect in ventricular sensing.

  • 4.

    This situation could be resolved by increasing the ventricular pacing pulse amplitude.

Suggest a solution to this ECG Contest at http://www.revespcardiol.org/en/electroreto/69/11. The answer will be published in the next issue (December 2016). #RetoECG.

Copyright © 2016. Sociedad Española de Cardiología
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