Interesting pacemaker strip...

Submitted by marc.strik on
Type traces
ECG
Device
ICD
Manufacturer
Medtronic

~~Patient was implanted with a dual chamber Medtronic pacemaker because of AV-block after RF ablation for AVNRT.

During device interrogation with testing we see this EGM.

What's going on on this strip? ECG is not connected (noise), EGM is the ventricular channel.

If you know the answer, perhaps you can also answer this question: is the patient at risk for PMTs?

Trace PDF

Submitted by sylvain.ploux on Mon 19/12/2016 - 10:16

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Nice one Marc,

To help I guess you can tell that the test was done in VVI mode, right?

Sylvain

Submitted by marc.strik on Mon 19/12/2016 - 11:53

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This was sent to me by a colleague from another hospital so I don't have more information.

But looking at the device behaviour, I assume it's VVI. :)

Submitted by bordacharp on Mon 19/12/2016 - 12:39

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Hi Mark, the pacing mode during the threshold test must be VDI 90bpm; when there is a ventricular capture, there is a 1/1 retrograde conduction explaining the aspect VP-AS; when you loose the ventricular capture, you see a slowing of the a trial rhythm ; there is a retrograde conduction, so there is a risk of PMT; at the end of the test permanent pacing mode (DDD) 

Pierre

Submitted by sylvain.ploux on Tue 20/12/2016 - 13:27

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Marcus

Unfortunatlty the management of PMT is going to be hard since Medtronic pacemakers need a VP-AS<400ms for a PMT to be recognized. I see that in your case VP-AS is above this limit...

SP