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Loss of Right Atrial Pacing Lead Capture Due to Myocardial Infarction Obscuring Diagnosis on Electrocardiogram

James A McCaffrey1, Bishnu P Dhakal1, Ashwin S Nathan2

  • 1Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

JACC. Case Reports
|August 1, 2022
PubMed

Insights

Right coronary artery occlusion can cause pacemaker lead failure. This can mask acute myocardial infarction, leading to delayed diagnosis and treatment.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Right coronary artery (RCA) occlusion is a critical event.
  • Pacemaker leads are essential for cardiac rhythm management.
  • Lead capture failure can complicate cardiac pacing.

Observation:

  • Acute myocardial infarction (MI) occurred due to RCA occlusion.
  • The right atrial pacing lead demonstrated capture failure.
  • This led to an increase in right ventricular pacing.

Findings:

  • The failure of the right atrial lead to capture was directly linked to acute MI.
  • Increased right ventricular pacing was a consequence of the atrial lead failure.
  • The altered pacing pattern masked the clinical signs of acute MI.

Implications:

  • Clinicians must consider lead performance during acute coronary syndromes.
  • Pacemaker function can obscure the diagnosis of myocardial infarction.
  • Awareness of this phenomenon is crucial for timely MI diagnosis and management.

Keywords:
MI, myocardial infarctionRA, right atriumRCA, right coronary arteryRV, right ventriclecardiac pacemakerelectrocardiogrammyocardial infarction

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