PMC3403576_01
Bedside antero-posterior Chest X rays showing atrial ring in the right ventricle.
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EKG showed a spontaneous rhythm at 70 bpm, narrow QRS, a long PR interval with intermittent Wenckebach phenomenon, chest X rays (Fig. 1) showed a relative cardiomegaly and a dislodged lead with displacement of the atrial ring into the right ventricle and the tip of the lead making a small loop at the apex of the right ventricle.
VVI-like pacing (paced 6th QRS complex) with AAI mode at nominal setting (3.6V/0.4 ms), the first QRS complex in precordial leads was not captured.
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PMC3403576_01_ccrep-5-2012-107f2.jpg
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The patient was reluctant to have any interventional procedure in order to relocate (or change) the lead; Consequently, pacing mode was switched to AAI resulting in VVI-like pacing mode (Fig. 2) with intermittent loss of capture at nominal setting (3.6V/0.4 ms), the threshold was at 2.0/0.4 ms and accordingly the atrial output was programmed at 4.5V/0.4 ms (Fig. 3).
Interrogation data and programmed parameters.
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PMC3403576_01_ccrep-5-2012-107f3.jpg
f3-ccrep-5-2012-107
The patient was reluctant to have any interventional procedure in order to relocate (or change) the lead; Consequently, pacing mode was switched to AAI resulting in VVI-like pacing mode (Fig. 2) with intermittent loss of capture at nominal setting (3.6V/0.4 ms), the threshold was at 2.0/0.4 ms and accordingly the atrial output was programmed at 4.5V/0.4 ms (Fig. 3).