Voluntary Asystole

Report:

Pacemaker rhythm 70/min 2

Somatic tremor 4

Pacemaker inhibition by myopotentials 4

Comment:

Unipolar pacemakers are more likely to be inhibited by myopotentials than bipolar ones. Muscle inhibition is rarely seen in modern pacemakers (this one is from 1976). In a totally pacemaker-dependent patient, the simplest therapy is to convert the demand unit to fixed-rate (asynchronous) mode. In this case, the patient was just advised to avoid straining his pectorals. Fortunately, he was not a body-builder.

It is important to ensure the patient’s safety from falls when performing this test. I did, but the patient refused to repeat the exercise, saying: “Now we know, fair enough”. He must have sensed I was after another recording for my own benefit.

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