Flutter with Failed Pacemaker

Report:

Atrial flutter 250/min 2

4:1 block 1

Failed pacemaker 3

Poor R wave progression 1

Nonspecific ST/T changes 1

Comment:

The intrinsic pacemaker rate is 70/min – the distance from the tip of the sensed R wave to the first pacing spike and also the distance between two short spike cycles. There is no atrial sensing: the F-spike relationship is random. This is a VVI pacemaker.

All the pacing spikes in this trace fall well before the native QRS complexes: they are not conducted because of pacemaker failure rather than because of ventricular refractoriness. The patient was readmitted for change of pacemaker lead. If she were to remain in atrial flutter – always an undesirable option – a VVI pacemaker mode - probably already programmed - should suffice.

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