Pacemaker-Ventricular 4:3 Block
Report:
Sinus rhythm 1
Atrial-sensing ventricular pacemaker 3
Trigeminy due to 4:3 pacemaker-ventricular block 6
Comment:
The paced beats show the expected RV apical pacing morphology of LBBB with LAD. The reason for the intermittent failure to pace is not apparent from the ECG. The sensing function is obviously preserved, as pacing spike follows every P wave, including the blocked ones.
There is some sinus arrhythmia, but no clear-cut relationship between the respiratory cycle and the dropped beats. That’s not to say it does not exist – the diaphragmatic pull may be the mechanism of stretching the electrode and changing its threshold about 20 times a minute (the rate of blocked spikes).
This patient does not seem to generate any native complexes and may be pacemaker-dependent.
Fig 78. 69 year old man in CCU with recent infarction.
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Pacemaker electronic DDD failure to capture Trigeminy pacemaker-ventricular 4-3 block
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