STRANGE DUAL CHAMBER STIMULATION

Abstract

Implantable cardiac devices (pacemaker, ICD, resynchronisation) are increasingly indicated in recent years. Complications secondary to these implants are encountered more frequently.We report the case of a 60 year old patient with a double chamber pacing device, implanted 6 months before her consultation date for a complete AVB.She was referred by her attending physician for exertional dyspnea and lipothymic discomfort following the implantation of the device.Clinical examination revealed no abnormalities. The ECG showed a spontaneous sinus rhythm at 60cpm.The interrogation of the device showed a DDDR pacing mode with the most frequent pacing mode in ASVS found at 80%.The EGMs listed were not consistent with the programmed dual chamber mode. The atrial endocavitary signals are labelled VS and the ventricular ones AP. The change of mode to VVI which should generate a ventricular drive showed us a spontaneous atrial signal coded VS. The AAI mode produces ventricular pacing with AP coded ventriculograms.A reversal of the lead connection at the box level was evoked.The patient has undergone a correct reconnection of the leads to the box with a rhythm at the end of the procedure in DDD.Follow-up telemetry 1 month after reconnection showed atrial and ventricular EGM signals appropriate to the paced and detected chamber.