AV Pacemaker: No Ventricular Lead

Report:

Atrial pacemaker rhythm 59/min 2

Right bundle branch block 2

AV interval 0.31” ?no ventricular lead 4

Q waves in 1, aVL, V5-6 – possible old anterolateral infarction 2

Comment:

The diagnosis is suggested by the unusually long AV interval, although, at times, similar intervals are deliberately programmed – See Case 3662. This patient’s ventricular lead retained normal impedance and could not be faulted except for very high threshold; it was changed.

The restored AV pacing is shown below (Fig 122a), with AV interval of 0.16”. While it would be tempting to retain the AV interval seen in AII mode (to give the patient a slim fusion QRS63), this would not last in view of the dynamic nature of native AV (i.e., PR) intervals.

Fig 122a.

Fig 123. 66 year old man with temporary pacemaker post-CABGs.

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