Inappropriate mode switching clarified by using a chest radiograph.
An 80-year-old woman with a history of paroxysmal atrial fibrillation and atrioventricular node disease status post-dual chamber pacemaker placement was noted to have abnormal pacing episodes during a percutaneous coronary intervention. Pacemaker interrogation revealed a high number of short duration mode switching episodes. Representative electrograms demonstrated high frequency nonphysiologic recordings predominantly in the atrial lead. Intrinsic pacemaker malfunction was excluded. A chest radiograph showed excess atrial and ventricular lead slack in the right ventricular inflow. It was suspected that lead-lead interaction resulted in artifacts and oversensing, causing frequent short episodes of inappropriate mode switching.
Division of Cardiology, Department of Internal Medicine, New York Hospital Queens/Cornell University Medical College, WA 200, 56-45 Main Street, Flushing, NY 11355, USA.
Brian
B
Marino
Department of Cardiology, Tulane University Heart and Vascular Institute, Tulane School of Medicine, New Orleans, LA 70112, USA.
Abhishek
A
Jaiswal
Division of Cardiology, Department of Internal Medicine, New York Hospital Queens/Cornell University Medical College, Cardiac Arrhythmia Center, 56-45 Main Street, Flushing, NY 11355, USA.
Seth
S
Goldbarg
Electrogram; Inappropriate mode switching; Oversensing; Pseudoatrial tachyarrhythmia; pacemaker artifact