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Background

  • 25 year had dual chamber pacemaker (DDD 60-170) implanted for intermittent complete heart block

  • Presented with palpitations (ECG below)

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Small pacing spikes followed by a narrow-ish (conduction system pacing-CSP) ventricular beat (ventricular capture) at ~125bpm

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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 positive in inferior leads, some variation in V1, peaked p waves – not likely sinus node origin.

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Possible diagnosis: likely 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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  • SVT/ATc-to be medically managed

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