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Background

  • Patient had dual chamber pacemaker (DDD 60-130) implanted for syncope and complete heart block

  • Presented with palpitations (ECG below)

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Small pacing spikes followed by a broad ventricular beat (ventricular capture) at ~120bpm

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Intrinsic p waves prior to each QRS, appears to be tracked and is therefore sensed -DDD.

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P wave morphology inverted in inferior leads. Inconsistent with sinus node origin.

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Possible diagnosis: PMT or atrial arrhythmia

 

Findings

  • Arrhythmia was diagnosed as a PMT

  • PVARP was lengthened to avoid tracking retrogade As.

  • Search AV was turned off (not required due to CHB) which was triggerring PMTs

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