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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.
JACC. Case Reports
|July 30, 2026
Summary
Pacemaker lead dislodgement is a risk post-implantation. Reviewing electrocardiograms and understanding device algorithms can prevent misinterpreting artifacts as lead issues, ensuring normal pacemaker function.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Symptomatic bradycardia and high-grade atrioventricular block necessitate pacemaker implantation.
- Left bundle branch area pacing is an advanced technique for specific conduction abnormalities.
Purpose of the Study:
- To report a case of suspected pacemaker lead dislodgement.
- To highlight the importance of artifact recognition in pacemaker function interpretation.
Main Methods:
- A patient received a dual-chamber pacemaker with a left bundle branch area pacing lead for symptomatic bradycardia.
- Post-implantation, an electrocardiogram suggested ventricular lead dislodgement.
- Device interrogation and analysis of manufacturer algorithms were performed.
Main Results:
- The suspected ventricular lead dislodgement was determined to be artifactual.
- Normal pacemaker function and sensing were confirmed after detailed analysis.
- No actual lead dislodgement occurred.
Conclusions:
- The period immediately following pacemaker implantation carries the highest risk for lead dislodgement.
- Post-implantation 12-lead electrocardiogram review is crucial for early detection of lead issues.
- Familiarity with device-specific algorithms aids in differentiating true abnormalities from artifacts in paced rhythms.
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