Shortness of breath and palpitations in an elderly man: Bad device behavior or malfunction?

70‐year‐old male with sinus node dysfunction (SND) and paroxysmal atrial fibrillation presents with shortness of breath and palpitations. Presenting EKG shows AF with rapid ventricular rates requiring direct current cardioversion (DCCV). Post‐DCCV EKG shows sinus rhythm with competing ventricular pa...

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Bibliographic Details
Published in:Journal of arrhythmia 2020-12, Vol.36 (6), p.1109-1111
Main Authors: Siroky, Gregory P., Lee, Shawn, Suri, Ranjit
Format: Article
Language:English
Subjects:
Aged
Atrial fibrillation
atrioventricular dyssynchrony
Conflicts of interest
ECG for Students & Assoc. Professionals
elective replacement indicator
Electrocardiogram
Electrocardiography
Heart
pacemaker syndrome
Pacemakers
Palpitation
Patients
permanent pacemaker
Sinuses
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Description
Summary:70‐year‐old male with sinus node dysfunction (SND) and paroxysmal atrial fibrillation presents with shortness of breath and palpitations. Presenting EKG shows AF with rapid ventricular rates requiring direct current cardioversion (DCCV). Post‐DCCV EKG shows sinus rhythm with competing ventricular pacing. Device interrogation demonstrates the patient's generator at the elective replacement indicator (ERI) and has been forced to VVI 65 bpm causing dyssynchronous ventricular pacing and inducing AF. This case highlights the importance of close device follow up with timely PPM generator change prior to ERI, especially in patients with Medtronic Adapta devices, to avoid unnecessary dyssynchronous ventricular pacing. In addition, device manufacturers should focus on maintaining AV synchrony in pacemakers when they reach ERI.
ISSN:1880-4276
1883-2148
DOI:10.1002/joa3.12446