A 70-year-old man with a personal history of hypertension, stroke, and single-vessel ischemic heart disease involving the right coronary artery treated with percutaneous placement of a drug-eluting stent, was admitted for syncope, hypotension, and severe bradycardia. A definitive DDD pacemaker was implanted with atrioventricular sensing set to 90ms and atrioventricular pacing set to 140ms.
An electrocardiogram was recorded during a follow-up visit (Figure), when the patient was asymptomatic.
What is the most likely diagnosis?
- 1.
Loss of ventricular capture due to lead dislodgement
- 2.
Loss of ventricular capture due to pacing of necrotic tissue
- 3.
Twiddler syndrome
- 4.
Normal pacemaker operation
Suggest a solution to this ECG Contest at http://www.revespcardiol.org/en/electroreto/70/02. The answer will be published in the next issue (March 2017). #ECG Contest.