The patient was 76 years old with recurrent vasovagal syncope and a mixed positive tilt table test. An AAIR<->DDDR mode pacemaker was implanted with minimum and maximum rates of 60 and 130 bpm, respectively, and an atrioventricular pacing interval of 150ms, with a managed ventricular pacing algorithm. After implantation, the patient had felt well for a while but returned to the clinic with a new episode of syncope. The Holter trace is shown in the Figure.
What is the diagnosis and what is the most appropriate approach?
- 1.
The syncope is related to failure of ventricular capture because the pacemaker lead has moved. The patient should be admitted immediately to hospital.
- 2.
The syncope is probably unrelated, failure of ventricular capture has occurred, and the patient should be examined.
- 3.
The syncope is probably unrelated, failure of atrial capture has occurred, and the patient should be examined.
- 4.
The pacemaker is working correctly.
Suggest a diagnosis to this ECG contest at http://www.revespcardiol.org/es/electroreto/70/8. The answer will be published in the next issue (September 2017). #EKGchallenge.