T Wave Sensing

Report:

Pacemaker rhythm 60/min 1

No atrial capture 2

No apparent atrial activity 3

Paced extrasystoles at 0.48 – 0.56” coupling; bigeminy

?T wave sensing 4

Comment:

One cannot be absolutely sure that there were no retrograde P waves at the time of the recording; there were certainly none at the time of pacemaker interrogation (when the rhythm was regular). There are slight variations in the coupling interval.

Most likely, despite their slow rate of rise (slew rate) the T waves are intermittently sensed.

The pre-implant bradycardia (Fig 96a), made worse by VEBs, is shown below, for completeness rather than interest.

Fig 96a. The left atrial abnormality indicates higher risk of AF. The QR extrasystoles in leads 3 and V1 may be a marker of previous infarction.

Fig 97. 78 year old lady with permanent pacemaker for sick sinus syndrome.

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