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Out-of-service lead: Abnormal presentation at follow-up
James C. Hansen, MD, Joshua D. Moss, MD, FHRS, Hemal M. Nayak, MD, FHRS, John F. Beshai, MD, FHRS Heart Rhythm Volume 10, Issue 1, Pages (January 2013) DOI: /j.hrthm Copyright © 2013 Heart Rhythm Society Terms and Conditions
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Figure 1 Pacemaker recordings. A: Shown from top to bottom are presenting rhythm, with ECG (limb lead III), atrial electrogram, and ventricular electrogram. Markers at the bottom indicate atrial pacing (AP) and ventricular pacing (VP). Device is programmed DDDR 60 with an AV delay of 120 ms during the recording. B: Recordings organized as in top panel, with device reprogrammed DDD 40 with an AV delay of 240 ms. The patient takes a deep breath after the first 2 beats and holds inspiration for the remainder of the tracing. See text for discussion. Heart Rhythm , DOI: ( /j.hrthm ) Copyright © 2013 Heart Rhythm Society Terms and Conditions
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Figure 2 Chest X-ray film. Left: Posteroanterior projection. Right: Lateral projection. Note the proximity of the capped (smaller-bore, passive fixation) right ventricular (RV) lead and the active (larger-bore, active fixation) RV lead. Right atrial lead position has been stable for more than 10 years. Heart Rhythm , DOI: ( /j.hrthm ) Copyright © 2013 Heart Rhythm Society Terms and Conditions
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Figure 3 ECGs. A: Device in DDD 60 mode with AV delay of 120 ms and increased atrial pacing output (5 1 ms). Pacing is consistent with right ventricular apical location, with small R wave noted in leads V1–V2. B: Device in VVI 60 mode, with overall similar morphology other than loss of R wave in leads V1–V2. Underlying atrial deflections consistent with the patient's history of sinus bradycardia are noted. Heart Rhythm , DOI: ( /j.hrthm ) Copyright © 2013 Heart Rhythm Society Terms and Conditions
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