Wobbly Atrial Lead
Report:
Sinus rhythm 86/min throughout 2
First degree AV block (PR 0.28”) 2
Left atrial abnormality (LAA) 1
Pacemaker rhythm (P-sensing) 86/min 2
AV interval 0.16” 2
Probable old inferior and septal infarction 1
Comment:
The atrial lead became wobbly following CABG surgery three months previously; it would pace the ventricles at shorter PR intervals in the same sinus rhythm, unpredictably, every now and then. This exacerbated the patient’s cardiac failure: pacing – not just broad complexes - produces less efficient ventricular output55.
The problem was at least partially solved by increasing the unit’s AV interval to 0.30”, ensuring completely native conduction, albeit with 1o AV block.
Below is a better quality ECG taken at the time of the patient’s CABGs, showing definite old inferior infarct. The tachycardia with normal PR interval is probably due to dobutamine infusion. The LAA was as impressive as ever, but the septal infarction is absent. The original trace’s QSs in V1-2 may have been positional.
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