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Isolating and Imaging Live, Intact Pacemaker Regions of Mouse Renal Pelvis by Vibratome Sectioning

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Tachycardia with alternating pacemaker spikes: Is it pacemaker malfunction?

Mahmoud Allahham¹, Mark Pollet², Jie Cheng³

¹Department of Medicine at Baylor College of Medicine, United States of America.

Journal of Electrocardiology

|January 7, 2019

Summary

A patient with multiple chronic conditions experienced tachycardia with alternating pacemaker spikes during a routine heart failure follow-up. This finding indicates a potential issue with the biventricular implantable cardioverter-defibrillator device or underlying cardiac rhythm.

Keywords:

Abnormal ECG Accelerated junctional rhythm Biventricular ICD Blanking period Digoxin toxicity Heart failure

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Area of Science:

Cardiology
Biomedical Engineering

Background:

The patient is a 67-year-old female with a history of type 2 diabetes mellitus, chronic kidney disease, and ischemic cardiomyopathy.
She has a biventricular implantable cardioverter-defibrillator (CRT-D) in place for cardiac management.

Observation:

The patient presented for a routine follow-up appointment at the Heart Failure clinic.
During the visit, she exhibited tachycardia accompanied by alternating pacemaker spikes on electrocardiogram (ECG).

Findings:

The presence of tachycardia with alternating pacemaker spikes suggests a potential device malfunction or an inappropriate pacing response.
This could indicate lead dislodgement, battery depletion, or a programming issue with the CRT-D device.

Implications:

Urgent evaluation and troubleshooting of the biventricular implantable cardioverter-defibrillator are necessary to determine the cause of the observed anomaly.
Prompt intervention is crucial to prevent potential adverse cardiac events and ensure optimal device function in managing the patient's heart failure and underlying cardiac conditions.