Agonal Rhythm: Pacemaker Failure?

Report:

Agonal (chaotic) rhythm 4

Pacemaker spikes 1

Slow rate 3

Failure to pace 2

Comment:

The pacemaker spikes may be slow due to inhibition by the native agonal complexes or because of the battery failure. A 12-lead ECG taken 7 months previously showed significant slowing of the pacemaker discharge (Fig 72a), consistent with battery depletion. It is likely that the initial cardiac arrest was in asystole or a bradyarrhythmia, with subsequent chaotic rhythm.

The reason for obtaining a full 12-lead ECG in this setting is unclear; it was standard practice in some US hospitals. I speculate it was their passion for “documentation” rather than some more venal reason that drove them to do this. There are, however, medico-legal implications of this practice, as this case shows.

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