Turk Kardiyol Dern Ars. Ahead of Print: TKDA-52386 | DOI: 10.5543/tkda.2018.52386
An Unusual Pacing Artifact
, Hakan Paydak, Naga Venkata Pothineni
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
INTRODUCTION Cardiac Implantable Electronic Devices (CIEDs) are widely used in current practice. Analyzing electrocardiographic patterns of these devices and knowledge of artifacts is crucial to appropriate CIED management.
Case Presentation: A 32 year old female patient presented to the device clinic for routine follow up. She had a dual chamber pacemaker implanted 12 years ago for sinus node dysfunction. Her initial 12 lead electrocardiogram (ECG) was concerning for cyclical pattern of rapid and multiple pacing stimulus artifacts. Device interrogation revealed normal overall pacemaker function. Turning the pace gain function off on the ECG machine failed to eliminate the artifact. On review of past medical history, she was found to have a diagnosis of congenital central hypoventilation syndrome and pulmonary hypertension for which she underwent insertion of a diaphragmatic pacemaker. Interrogation of the diaphragmatic pacemaker revealed that the programmed parameters correlated with the frequency of the artifact noted on the ECG.
DISCUSSION In cardiac pacing, a single stimulus artifact of sufficient threshold can enable myocardial capture. On the other hand, capturing the diaphragm requires a train of multiple stimuli above the threshold. Thus, an understanding of the pacing configurations of various electrical devices that can potentially interfere with CIEDs is crucial in appropriate patient management.
Pacemaker, Artifact, Electrocardiogram
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Corresponding Author: Amjad Abualsuod, United States