Patient had insertion of a dual chamber pacemaker. At one-month follow-up this is his 12-lead ECG. What’s the problem?
The paced ecg shows that the ventricular capture is being achieved by the first pacing spike and the second pacing spike is within the QRS. This indicates that ventricular capture is being achieved by the atrial lead and therefore the atrial lead must have displaced into the ventricle. This can be confirmed by a chest x-ray. if the atrial lead is an active fixation (screw in), prompt revision of the lead is advised due to the risk of having an exposed screw within the heart.