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Related Experiment Videos

"Sensing alternans" in a patient with a newly implanted pacemaker.

Amgad N Makaryus1, Bernard Boal

  • 1Division of Cardiology, Section of Electrophysiology, North Shore University Hospital, Manhasset, New York 11030, USA.

Clinical Cardiology
|April 7, 2006
PubMed
Summary

A pacemaker lead perforated the heart wall, causing acute pericarditis and irregular atrial sensing. This case highlights a rare complication after dual lead pacemaker implantation.

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Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Pacemaker implantation is a common procedure for cardiac rhythm management.
  • Coronary artery disease is a prevalent comorbidity in patients requiring pacemakers.
  • Acute pericarditis is an inflammation of the pericardium, the sac surrounding the heart.

Observation:

  • An 80-year-old male with coronary artery disease presented with symptoms of acute pericarditis.
  • The patient had recently undergone dual lead pacemaker implantation.
  • Electrocardiogram showed sinus rhythm with intra-atrial conduction delay and intermittent atrial sensing failure ('sensing alternans').

Findings:

  • Pacemaker lead perforation of the ventricular wall was identified as the cause of pericarditis.

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  • Pericardial effusion and lead displacement were associated with the observed 'sensing alternans'.
  • This indicates a direct mechanical complication from the implanted device.

    • Implications:

    • This case underscores the importance of recognizing rare but serious complications following pacemaker implantation.
    • Accurate diagnosis requires correlating clinical presentation with electrocardiographic findings.
    • Prompt management is crucial to prevent further cardiac compromise.