Unexplained syncope during pacemaker interrogation: Wand, AutoCapture, or lead—Which one is the elusive culprit?
Autor: | Rakesh Sarkar, Ayan Kar, Subir Ghose, Suchit Majumder, Debabrata Bera, Sanjeev S. Mukherjee |
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Rok vydání: | 2021 |
Předmět: |
Male
Pacemaker Artificial medicine.medical_specialty Heart block 030204 cardiovascular system & hematology Culprit Asymptomatic Syncope 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Lead failure Humans 030212 general & internal medicine Lead (electronics) Interrogation Aged Dual Chamber Pacemaker business.industry General Medicine medicine.disease Cardiology Equipment Failure medicine.symptom Cardiology and Cardiovascular Medicine business Syncope (phonology) |
Zdroj: | Pacing and Clinical Electrophysiology. 44:1231-1235 |
ISSN: | 1540-8159 0147-8389 |
Popis: | A 65 year-old-gentleman underwent dual chamber pacemaker implantation (DDDR, St Jude Medical) 7 years back for infra-hisian complete heart block. He was completely asymptomatic and came for his annual routine check-up. After undergoing ECG with and without magnet, he was prepared for device evaluation. After placing the programmer wand over the chest as soon as the 'interrogate' button on the programmer screen was pressed, the patient immediately experienced pre-syncope but recovered instantly as the wand was promptly withdrawn. After taking him to the casualty room with all resuscitation measures in hand, a repeat attempt of interrogation was made after connecting ECG, which revealed reproducible loss of capture (LOC), exclusively during wand placement. A differential diagnosis of lead failure, battery depletion or wand related issues were considered. However, serial ECGs recorded without wand raised the possibility of AutoCapture malfunction. With all precautions, the device was programmed to fixed ventricular output mode after which interrogation could be performed safely. There was a remaining battery longevity of 2 years with acceptable lead parameters and stable threshold. He continues to be asymptomatic at 10 months of follow up. This article is protected by copyright. All rights reserved. |
Databáze: | OpenAIRE |
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