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Vol. 73. Issue 5.
Pages 409 (May 2020)
ECG Contest
DOI: 10.1016/j.rec.2019.10.020
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Response to ECG, April 2020
Respuesta al ECG de abril de 2020
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Sara Lozano Jiménez
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sara12s@hotmail.com

Corresponding author:
, Jorge Toquero Ramos, Xabier Cía Mendioroz
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Rev Esp Cardiol. 2020;73:32710.1016/j.rec.2019.10.017
Sara Lozano Jiménez, Jorge Toquero Ramos, Xabier Cía Mendioroz
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The correct answer is option 1. On observing the device (figure 1: upper trace, pacing channel; middle trace, atrial electrogram; lower trace, ventricular electrogram), T-wave oversensing can be seen (ovals). This affects detection of the following intrinsic atrial activity in the blanking period (Ab), which is not followed by ventricular pacing.1

Figure 1
(0.07MB).

Atrial activity corresponds to sinus rhythm at 90 bpm, with occasional far-field ventricular sensing (Ab intercalated between As and Ab from the third complex onwards), not to atrial tachycardia (response 2 incorrect).2

There is no progressive lengthening of the atrioventricular signal prior to the onset of slow frequencies, and Wenckebach behavior at this frequency would not be expected (response 3 incorrect).2

There is no sinus tachycardia that could lead to capture of every other P wave within the postventricular atrial refractory period (response 4 incorrect).2

Reductions were implemented in ventricular sensitivity (avoiding T-wave oversensing) and atrial sensitivity (avoiding far-field sensing), thereby resolving both problems.

References
[1]
S.S. Barold.
Complications of Pacemaker Implantation and Troubleshooting.
Interventional Electrophysiology, pp. 935-1054
[2]
P.A. Levine, C.J. Love.
Pacemaker diagnostics and evaluation of pacing system malfunction.
Clinical Cardiac Pacing and Defibrillation, 2nd ed., WB Saunders, (2000), pp. 827-875
Copyright © 2019. Sociedad Española de Cardiología
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