Abstract
A 67-year-old male patient received a pacemaker for syncope. His parameters at check-up were: P/R amplitude 2.8/11 mV and atrial/ventricular threshold 0.875/0.625. The pacemaker was programmed as follows: lower rate 60 bpm; upper tracking rate 130 bpm; sensed AV interval 120 ms; paced AV interval 50 ms; atrial/ventricular sensitivity 0.5/5.6 mV, and atrial/ventricular output 2/2 V. Due to syncope in his history, the rate drop response was also activated: drop size 25 bpm; drop rate 50 bpm; detection beats: 2 beats. Both with an intervention rate of 100 bpm. The following ECG was recorded during carotid massage (Fig. 1). What is the explanation for this interesting ECG recording? Fig. 1 ECG recording during carotid massage: Lead I, marker channel, ventricular EGM
Highlights
Temporary severe bradycardia due to pacemaker programming
As a result of carotid massage, sinus bradycardia and AV blockade develop, the A sense-A sense interval is lengthened to 1360 ms, and the P wave is not followed by R wave transmission
Since there is no further P wave, an atrial spike follows after 1200 ms, with the lower rate set at 50 bpm
Summary
Temporary severe bradycardia due to pacemaker programming As a result of carotid massage, sinus bradycardia and AV blockade develop, the A sense-A sense interval is lengthened to 1360 ms, and the P wave is not followed by R wave transmission.
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