A 57-year-old man with permanent atrial fibrillation and severe systolic dysfunction due to ischemic heart disease and heart failure was implanted with a Medtronic Amplia cardiac resynchronization therapy device (Medtronic; Minneapolis, Minnesota, United States) with no incidents. On the night of the procedure, the duty cardiologist was alerted because of pauses in the telemetry recording (Figure 1).
Based on the telemetry, what was the correct diagnosis and what might have happened?
- 1.
Capture failure has occurred, possibly because of incorrect placement or electrode dislocation.
- 2.
Loss of capture has occurred in the right ventricle, but the device is functioning normally.
- 3.
Loss of capture has occurred in the left ventricle, but the device is functioning normally.
- 4.
This is an inappropriate telemetry warning due to poor differentiation between spikes and QRS.
Submit your answer to http://www.revespcardiol.org/en/electroreto/72/9. The answer will be published in the next issue (October 2019). #RetoECG.