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Background

  • Patient came in with irregular and fast ventricular pacing (ECG shown below)

 

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There are pacing spikes followed by broad ventricular beats (ventricular capture).

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The underlying rhythm is AF & there does not appear to be any atrial pacing spikes.

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Cannot be single chamber mode - too much variability in rate of ventricular pacing.

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Ventricular sensing appropriate = the slowest paced RR is the same as the sensed to paced RR

 

Findings

  • Intermittent undersensing of AF, resulting in failure to mode switch

  • & fast, irregular V pacing (start of rhythm).

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Troubleshooting


  • Adjust atrial sensitivity

  • Increase atrial sensitivity

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  • Mode

  • If permanent AF, consider VVIR​​​​​​​

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