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An Electrocardiographic Artifact Mimicking Pacemaker Malfunction
Anish S Shah1, Marc C Engels2, Klitos Konstantinidis2
1Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City, Utah, USA; Department of Medicine, George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA.
Case Summary:
A patient presents with symptomatic bradycardia and high-grade atrioventricular block and receives a dual-chamber pacemaker with left bundle branch area pacing lead. Post procedure, there is concern for dislodgement of the ventricular lead after an electrocardiogram shows a missing ventricular paced beat. After additional device interrogation and review of the device manufacturer algorithms, it was determined that what was thought to be loss-of-capture or loss-of-sensing was coincidental artifact and normal device function.
Take-Home Messages:
The highest risk for pacemaker lead dislodgement is immediately after implantation, and a 12-lead electrocardiogram should be reviewed post implantation. Understanding device manufacturer algorithms can help interpret unusual artifacts and findings in paced rhythms.
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