No spikes (Can be so benign to ultimate danger ) Spikes more than QRS – Indicate capture failure. Simple pauses – Any pause more than the pacing interval is a definite concern. (In DDD mode we have a rare PM mediated re-entrant tachycardia, which is mainly used to grill cardiology fellows in their board exams with all those PVARP stuff !) If the rate never goes down, what to do ? Try a carotid massage or observe a nocturnal ECG or call analyst and increase the rate to document pacing. Just ensure spikes reappear when the rate falls below 70. Many of them are in own sinus rhythm or AF. Tachycardia -No spike.( Not to worry ?) A common situation if the original indication was sinus node dysfunction. Since ,in a paced patient HR cannot be less than programmed rate of 70. A new onset tachycardia, which is either a part of brady- tachy syndrome or separate arrhythmia can continue to provoke the symptom.īradycardia /Often implies back to original rhythm – Indicates real trouble. **Never forget syncope is not an exclusive symptom of bradycardia. ![]() It could suggest alternative hemodynamic explanation like vaso-depressive component of vagal syncope ,autonomic dysfunction, orthostatic intolerance or a coexisting neurological /systemic condition. This would mean, the original symptom for which pacemaker was put is not related to the Brady-arrhythmia. Few patients may continue to have significant symptoms in-spite of normal pacemaker parameters. * Syncope can be unrelated to pacemaker but always consider them electrical unless proved otherwise. ![]() Near syncope – Show some concern (For many, Impending true syncope is a non existent entity ).Vague dizziness – Pacemaker syndrome ? Anxiety ?.May be ,we can expect a warning siren in the future ? ) ( Please note, pacemakers do not stop all of a sudden it has a intrinsic end of life indicators. Beyond 8-10 years /Near end of life – 95% Energy depletion leads issues.After first year – Generally Issues are rare, Lead issues, Associate disease progression.Within 6 months – Benign pacemaker syndrome ,Threshold settings, Scars. ![]()
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