We report the case of an 86-year-old woman who presented to the emergency department with syncope and spasms in left upper extremity. She had recently undergone implantation of a dual-chamber pacemaker because of symptomatic, paroxysmal, complete atrioventricular block secondary to syncope. Figure 1 shows the electrocardiogram on her arrival at the emergency room and Figure 2, the chest radiograph.
Which diagnosis is most probable?
- 1.
Loss of ventricular capture and loss of atrial sensing and capture due to ratchet syndrome.
- 2.
Loss of ventricular capture and loss of atrial sensing and capture due to twiddler syndrome.
- 3.
Loss of ventricular capture and loss of atrial sensing and capture due to reel syndrome.
- 4.
Loss of ventricular capture due to probable ionic remodeling. Atrial lead not implanted.
Suggest a solution to this ECG contest at http://www.revespcardiol.org/es/electroreto/69/07 #RetoECG (only Spanish). The answer will be published in the next issue (August 2016).