[Pacemaker ECG quiz no. 24. Implanted the wrong device?].

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Syncope of unknown origin necessitates diagnostic tools for accurate arrhythmia detection.
• Implantation of a dual-chamber pacemaker is a common intervention for bradycardia and sinus node disease.
• Cardiac loop recorders provide continuous electrocardiogram monitoring for extended periods.

Observation:

• A 73-year-old patient with syncope underwent loop recorder implantation, diagnosing sinus node disease.
• Following dual-chamber pacemaker implantation, the loop recorder was intentionally not removed.
• The patient later reported dizziness and palpitations, prompting a device evaluation.

Findings:

• Pacemaker interrogation yielded no significant findings.
• The retained loop recorder successfully captured and stored several critical arrhythmias.
• These arrhythmias were not evident during routine pacemaker follow-up.

Implications:

• This case underscores the potential benefit of retaining cardiac loop recorders post-pacemaker implantation.
• Continuous monitoring via loop recorders can detect intermittent arrhythmias missed by pacemaker diagnostics.
• Non-explantation of loop recorders may enhance diagnostic yield in patients with persistent or recurrent symptoms.