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09-06-2016 | Rhythm Puzzle Answer | Uitgave 7-8/2016 Open Access

Netherlands Heart Journal 7-8/2016

Temporary severe bradycardia due to pacemaker programming

Tijdschrift:
Netherlands Heart Journal > Uitgave 7-8/2016
Auteurs:
A. Böhm, R. G. Kiss, P. Bogyi, G. Z. Duray

Answer

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. Due to the managed ventricular pacing (MVP) function, at 80 ms following a non-transmitted atrial event, ventricular stimulation follows; this can be seen after the 2nd atrial paced beat (Ap) which is then followed by another Ap at 1200 ms, without a subsequent QRS, as a result of carotid sinus massage. The next Ap-Ap (3rd and 4th) interval is 600 ms (Fig.  1). This could be explained as follows: the rate drop response is activated by a rhythm of 50 bpm frequency for two beats, leading to an atrial-ventricular stimulation of 100 bpm. The pacemaker is working correctly; the interesting ECG recording is due to the combination of MVP and rate drop functions. Considering the significant decrease in ventricular frequency observed in this case, MVP and rate drop functions should not be programmed simultaneously.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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