September 2019

Bradycardia on Telemetry following a pacemaker implant

Jason Collinson – Chief Cardiac Physiologist
Essex Cardiothoracic Centre, Basildon and Thurrock University Hospital
jason.collinson@btuh.nhs.uk

A 60 year old male was implanted with a Sorin/MicroPort dual chamber pacemaker following an emergent admission for syncope associated with intermittent AV block. Three hours post implant telemetry captured an episode of bradycardia displayed in figure 1. An urgent pacemaker check was requested with concern that there was device malfunction. The device settings programmed at implant are displayed below.

Mode: AAI-DDD (SafeR)
Lowere rate: 60 bpm
Upper rate: 130 bpm
Paced AV delay: 220 ms
Sensed AV delay 155 ms

Figure 1
Telemetry recording showing an episode of bradycardia a few hours after de-novo pacemaker implant. ECG leads displayed are lead I (top) and V1 (bottom)

QUESTION

Which answer best explains the telemetry recording?

  • Loss of atrial capture

  • Ventricular oversensing

  • Normal pacemaker behaviour

  • Loss of ventricular capture

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