DDD Pacemaker in Acute Infarction with 2:1 AVB
Report:
Sinus tachycardia 124/min
2:1 AV block
A-sensing ventricular pacemaker rhythm 62/min
Fusion beats
Acute or recent inferolateral infarction
Comment:
My first thought was something exotic: accrochage between the temporary pacemaker and the sinus tachycardia, halved by AVB. I had never seen such accrochage. I had never seen a dual pacemaker used for acute infarction in our CCU, either. Well, this was one and a permanent implant at that. The patient sustained a large infarct and died a few weeks later. The DDD unit seemed to his Cardiologist simpler and more reliable to provide hæmodynamic support during the critical initial period.
The pacing AV interval must have been extended beyond the native conducted PR interval of 0.22” to allow P waves to activate the atria.
The LAD is not reported, being due to combination of inferior infarction and the pacemeker. We can be sure there is no LAHB as well, given the secondary R waves in the inferior leads and their absence in aVR.
Below (fig 127a) is a trace taken two days later (the AV interval shortened), in sinus tachycardia, in 1:1 conduction.
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Tags
av block sensing alternate p waves fusion pacemaker-sinus myocardial infarction acute
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