Type de tracés

ECG

Prothèse

ICD

Constructeur

Medtronic

This 81-year old patient with a dual chamber pacemaker (implanted in 2015 for sick sinus syndrome) was admitted because of chest pain for which he will receive coronary angiography.

This strip of ECG telemetry was printed because it caught the attention of the attending nurse (see circles drawn on the stip).

What do you think is happening? Is it normal pacemaker behaviour? Which brand pacemaker is this?

Tracé PDF

My take: junctional rhythm

My take: junctional rhythm surpassing the atrial rate, resulting in intermitting cross talk with VSP.

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Thanks Dr. Lüker for the

Thanks Dr. Lüker for the excellent take! But I don't think there is cross talk.

The junctional rhythm is indeed surpassing the atrial rate, resulting in ventricular sensed events (QRS-complexes) occuring during the safety window (within 110 ms after atrial pace) which triggers ventricular safety pacing.. This is normal MEdtronic pacemaker behaviour.

This is explained in more detail in this example: http://www.pacingdefibrillation.com/en/traces/pm/medtronic/blanking-safety-window-av-delay-0

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Thanks Mark! Crosstalk was

Thanks Mark! Crosstalk was certainly the wrong terminology. What I meant was VSP because of safety window sensing ;)

Naming the manufacturer was a tough one because the 110ms were hard to measure and I couldn't find a list of VSP intervals for all manufacturers (SJM 120ms? no VSP for Boston, Bio?, Sorin?).

Inappropriate spikes on telemetry?

My take: junctional rhythm

Thanks Dr. Lüker for the

Thanks Mark! Crosstalk was

Marc,