jabbrv-ltwa-all.ldf jabbrv-ltwa-en.ldfINTRODUCTION
Pacemaker interrogation is an important process during the patients with pacemaker implantation, which relates to a life-threatening matter. The consequences associated with pacemakers including various items such as output malfunction, capture failure, extended RR intervals, or even cardiac arrest. It is rare that three spike signals were observed during the AV delay, which is more commonly seen in cases of CRT, His bundle pacing, and left bundle branch pacing.
CASE PRESENTATION
A 51-year-old man with a permanent pacemaker implanted 15 years ago for sick sinus syndrome presented to the emergency department after experiencing a week of palpitations. He had not regularly followed up on the pacemaker after the operation. Two weeks ago, he had a dual-chamber pacemaker implanted due to battery depletion in other hospital. A bedside electrocardiogram (ECG) and chest X-ray were obtained (Figures 1 and 4 a).
Upon arrival at the emergency department, his heart rate was 60 beats per minute (bpm), respiratory rate was 21 bpm, blood pressure was 123/61 mmHg, and oxygen saturation was 98% on room air, with a normal body temperature. The patient underwent a comprehensive cardiovascular, pulmonary, and neurological workup, which excluded structural diseases. The levels of electrolytes, glucose, cardiac enzymes, N-terminal pro-brain natriuretic peptide (NT-ProBNP), coagulation tests, D-dimer, renal and liver functions, and complete blood count were all normal. Despite this, the patient repeatedly complained of palpitations, prompting the performance of two additional bedside ECGs (Figures 2 and 3).