Allorhythmic Failure to Pace & Sense

Report:

Sinus rhythm 59/min 1

First degree AV block 1

Non-specific ST/T changes 1

Demand pacemaker 75/min 2

Trigeminy 1

Intermittent failure to pace 1

Possible intermittent failure to sense 1

Comment:

Of every three pacemaker spikes, only one - the middle one - captures the ventricles. It may be that this patient is not pacemaker-dependent, but the device would, normally, require revision in case the original indication returns.

The sensing failure is not certain in this case. The native QRS complex following the first “empty” spike is obviously not sensed; but it is close enough to the spike to be ignored for falling within the ventricular refractory period of the pulse generator.

The trigeminy consists of two sinus beats followed by a paced beat; the additional pacemaker spike trigeminy does not ‘count’ since only one QRS complex is involved.

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