What is the mechanism of irregular pacing spikes? Pacing failure, sensing failure, or something else? A case report

Gaku Oguri; Toshiya Kojima; Katsuhito Fujiu; Issei Komuro

doi:10.1093/ehjcr/ytaa065

What is the mechanism of irregular pacing spikes? Pacing failure, sensing failure, or something else? A case report

Eur Heart J Case Rep. 2020 Apr 4;4(3):1-4. doi: 10.1093/ehjcr/ytaa065. eCollection 2020 Jun.

Authors

Gaku Oguri^{1

2}, Toshiya Kojima¹, Katsuhito Fujiu^{1

3}, Issei Komuro¹

Affiliations

¹ Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan.
² Clinical Research Support Center, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan.
³ Department of Advanced Cardiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan.

Abstract

Background: In cardiac implantable electronic device management, confused electrocardiograms are sometimes encountered.

Case summary: We experienced a case of dizziness and presyncope, which was accompanied by irregular pacing spikes following QRS complexes, pacing failure, sensing failure, or something else. The patient's second active pacemaker in her left chest was functioning normally. However, her old abdominal pacemaker had automatically changed from the OVO to VVI mode because of an elective replacement indicator. As a result, her old and second pacemakers had an interaction. Old invalid pacing spikes induced oversensing of the current pacemaker, which interfered with valid pacing.

Discussion: We experienced a rare case of dizziness and presyncope with confused pacing spikes. Physicians should be aware of the unexpected interactions that are possible with devices with automatic mode changes.

Keywords: Automatic mode change; Case report; Irregular pacing; Pacemaker interaction.

Publication types

Case Reports