Pretend-Sequential Pacemaker

Report:

Pacemaker rhythm 60/min 4

Failed atrial capture 5

Possible retrograde conduction 1

Comment:

The atrial spikes precede an empty AV interval – there is no evidence of atrial activity. A trace taken 5 months previously (below) was essentially the same (same pre-set rate 60/min, too).

There is no obvious retrograde conduction, but a slight wrinkle in the ST segments may be a retrograde P wave. Formal pacemaker interrogation would prove retrograde activation of the atria, if present. The patient had recurrent pancreatitis, with systolic pressures ranging between 80 and 110 mmHg; she could have used some atrial transport.

She could well have symptoms consistent with pacemaker syndrome, perhaps, at her age, overshadowed by other “co-morbidities”.

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