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Vol. 71. Issue 10.
Pages 860 (October 2018)
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Vol. 71. Issue 10.
Pages 860 (October 2018)
ECG Contest
DOI: 10.1016/j.rec.2018.01.024
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Response to ECG, September 2018
Respuesta al ECG de septiembre de 2018
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Alejandro Cruz Utrillaa,
Corresponding author
acruzutrilla@gmail.com

Corresponding author:
, Javier Higuerasa, Juan José González Ferrerb
a Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
b Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
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Rev Esp Cardiol. 2018;71:75310.1016/j.rec.2018.01.023
Alejandro Cruz Utrilla, Javier Higueras, Juan José González Ferrer
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The correct answer is number 3. Initially, the pacemaker works in AAI mode with first-degree atrioventricular block (AVB) (asterisk) until a blocked atrial event occurs (star). Subsequently, a paced ventricular event is assured after loss of atrioventricular (AV) conduction (cross). Afterwards, an absent second ventricular event presents (star) with a switch to DDD mode and reduction of the paced AV delay to 220 ms (hash). This is all part of the managed ventricular pacing mode1 of the patient's pacemaker device (Medtronic Ensura) (Figure).

This is not a ventricular sensing failure, as the pacemaker is able to correctly sense appropriate ventricular events (answer 1, correct). Likewise, it is not programming of a variable 400 ms paced AV delay, as this cannot be programmed (answer 2, incorrect). Finally, the blocked atrial activity is not derived from progressively longer AV intervals, as would be required with Wenckebach AVB (answer 4, incorrect).

.

Reference
[1]
M. Almehairi, C. Simpson, J.C. Caldwell, A. Baranchuk.
Mode switching during managed ventricular pacing algorithm: what is the mechanism?.
Pacing Clin Electrophysiol., 37 (2014), pp. 646-649
Copyright © 2018. Sociedad Española de Cardiología
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