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Background

  • Patient had dual chamber pacemaker (DDD 60-120) implanted for syncope and complete heart block

  • Years after initial implant presented with recurrent syncope (ECG shown below)

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Large pacing spikes (appear to be unipolar/high output pacing) followed by a broad ventricular beat (ventricular capture) at ~70 bpm.

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No atrial paced event or p wave prior to ventricular pacing spikes (inconsistent with DDD)

Start of ECG = SR with CHB, no ventricular pacing.

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Pacing rate of 70 appears to be violated and is consistent with V oversensing, withholding V pacing

 

Findings

  • Safety mode triggered and unable to be reprogrammed.

  • Generator had to be replaced (device advisory)

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