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Vol. 70. Issue 3.
Pages 198 (March 2017)
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Vol. 70. Issue 3.
Pages 198 (March 2017)
ECG Contest
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Response to ECG, February 2017
Respuesta al ECG de febrero de 2017
Javier Le??n Jim??nez
Corresponding author

Corresponding author:
, Santiago Jes??s Camacho Freire, Ra??l L??pez Aguilar
Servicio de Cardiolog??a, Complejo Hospital Juan Ram??n Jim??nez, Huelva, Spain
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Rev Esp Cardiol. 2017;70:11910.1016/j.rec.2016.11.012
Javier León Jiménez, Santiago Jesús Camacho Freire, José Raúl López Aguilar
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The correct answer is number 4. This dual-chamber pacemaker is functioning normally. There are 2 leads, 1 for pacing the Bachmann interatrial bundle and the other for pacing the bundle of His. The resulting bipolar physiological Hisian pacing does not lead to any changes in QRS morphology (Figure 1).

Figure 1

Given the particular features of pacing in this case, there is no loss of capture (answers 1 and 2) because all the spikes are still present in the QRS complex. Twiddler syndrome (answer 3) is ruled out by chest x-ray (Figure 2).

Figure 2
Copyright © 2016. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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