November 2018

A 12 lead ECG recorded post DDD pacemaker implant

Jason Collinson – Chief Cardiac Physiologist
Essex Cardiothoracic Centre, Basildon and Thurrock University Hospital
jason.collinson@nhs.net
Twitter: @cardiacjase

Background

A 60 year old patient with a history of sick sinus syndrome implanted with a DDD pacemaker had a routine 12 lead ECG post implant.  The 12 lead ECG is displayed in figure 1. The device settings are as follows.

Mode     AAI-DDD
LR/UR     60/130 bpm
Paced/Sensed AV delay  200/180 ms
A output    3.5 V at 0.35 ms
A sensitivity   1.0 mV
V output    3.5 V at 0.35 ms
V sensitivity   2.5 mV

Figure 1
A 12 lead ECG recorded 60 minutes post dual chamber pacemaker implant

THE QUESTION

What does the ECG display?

  • Atrial capture, intermittent atrial undersensing, DDD mode operation.

  • Atrial capture, atrial undersensing, AAI mode operation.

  • Atrial capture, intermittent atrial undersensing, AAI mode operation.

  • Loss of atrial capture, atrial undersensing, DDD mode operation.

VIEW ANSWER

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