PMC5420029_01
Electrocardiogram (ECG) showing sinus rhythm at approximately 100 beats per minute (bpm) with complete heart block and a junctional escape rhythm of 47 bpm with intermittent ventricular undersensing and complete loss of ventricular capture. A: There was up to 4 mm ST-segment elevation in the inferior leads (II, III, and aVF) with minor ST elevation in the anterior leads and ST-segment depression in the lateral leads. B: ECG after pacemaker reprogramming (increased amplitude and pulse width) showing consistent right ventricular capture.
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III, and aVF), consistent with inferior MI (Figure 1A). Immediate pacemaker interrogation showed a significant increase in RV pacing thresholds (4.0 V @ 0.5 ms) with intermittent RV sensing at 2 mV. Immediate, consistent RV capture was obtained by increasing the RV stimulation output to 7.0 V @ 1.5 ms (Figure 1B), and hemodynamic stability was achieved.
Right coronary angiography in the left anterior oblique (LAO) position (A) and in the right anterior oblique (RAO) position (B) showing the right coronary artery and its branches in close proximity to the pacemaker lead tip.
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After RCA reperfusion, several coronary branches to the right ventricle could be identified, some of them in close proximity to the pacemaker lead tip (Figure 2).