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Vol. 69. Issue 8.
Pages 784 (August 2016)
ECG Contest
DOI: 10.1016/j.rec.2016.03.023
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Response to ECG, July 2016
Respuesta al ECG de julio de 2016
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Pablo Elpidio García-Granja
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pabloelpidio88@gmail.com

Corresponding author:
, Elvis J. Amao Ruiz, Emilio García-Morán
Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Rev Esp Cardiol. 2016;69:69710.1016/j.rec.2016.03.022
Pablo Elpidio García-Granja, Elvis J. Amao Ruiz, Emilio García-Morán
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The electrocardiogram (Figure, panel B) shows the double spikes typical of dual-chamber (DDD) pacemakers. The first beat (*1) corresponds to the native QRS following the double spikes, with a prolonged PR interval, indicating the loss of ventricular capture. This loss is not permanent; the following 4 beats show a paced QRS (----) and the fifth (*5), again a loss of capture. The P waves are evident (^), but there are no adequate data on atrial detection or capture.

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(0.28MB).

The diagnosis is reel syndrome (option 3), caused by lead dislodgement due to generator rotation over its sagittal axis.1 The lead winds around the generator as though the latter were a reel (Figure, panels A and C) (Figure, panels A and C: chest radiographs following implantation and in the emergency department, respectively). In twiddler syndrome, the rotation of the generator causes the lead to wind around itself, forming a braid.1 In ratchet syndrome, there is no rotation and, usually, only the lead is affected.1 Option 4 is a distractor; the dislodged atrial lead can be seen in the generator pocket (Figure, panel C), and caused the spasms in the upper extremity described by the patient.

Reference
[1]
M.A. Arias, M. Pachón, A. Puchol, J. Jiménez-López, B. Rodríguez-Picón, L. Rodríguez-Padial.
Ordenación terminológica sobre macrodislocación de electrodos de dispositivos cardiacos electrónicos implantables.
Rev Esp Cardiol., 65 (2012), pp. 671-673
Copyright © 2016. Sociedad Española de Cardiología
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