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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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Published in: | Journal of arrhythmia 2020-12, Vol.36 (6), p.1109-1111 |
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description | 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. |
doi_str_mv | 10.1002/joa3.12446 |
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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.</description><identifier>ISSN: 1880-4276</identifier><identifier>EISSN: 1883-2148</identifier><identifier>DOI: 10.1002/joa3.12446</identifier><identifier>PMID: 33335635</identifier><language>eng</language><publisher>Japan: John Wiley & Sons, Inc</publisher><subject>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</subject><ispartof>Journal of arrhythmia, 2020-12, Vol.36 (6), p.1109-1111</ispartof><rights>2020 The Authors. published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.</rights><rights>2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.</rights><rights>COPYRIGHT 2020 John Wiley & Sons, Inc.</rights><rights>2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). 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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.</description><subject>Aged</subject><subject>Atrial fibrillation</subject><subject>atrioventricular dyssynchrony</subject><subject>Conflicts of interest</subject><subject>ECG for Students & Assoc. Professionals</subject><subject>elective replacement indicator</subject><subject>Electrocardiogram</subject><subject>Electrocardiography</subject><subject>Heart</subject><subject>pacemaker syndrome</subject><subject>Pacemakers</subject><subject>Palpitation</subject><subject>Patients</subject><subject>permanent pacemaker</subject><subject>Sinuses</subject><issn>1880-4276</issn><issn>1883-2148</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp9kktvEzEQx1cIREvgwgdAlrggpAS_veYAChWPoko9ACcO1qzXmzjatVN7E5Rvj5OUQhDCD9ka_-Y_ntFU1VOCZwRj-moVgc0I5Vzeq85JXbMpJby-f7jjKadKnlWPcl5hLGpOyMPqjJUhJBPn1fcvy5jG4HJGsUNNcjAuEYQWraFf-xFGH0NGPhQbcn3rUr9DA4TX6B20qHVbbx1q3BK2PiZU1gB9twl27_b2cfWggz67J7fnpPr24f3Xi0_Tq-uPlxfzq6kVkstpU75iHQggRLCu1ZI0nRYWOlBSslqCJdpqoaRqlOUtFBzqWuqOC6pBWDapLo-6bYSVWSc_QNqZCN4cDDEtDKTR294ZYalmWNZUOMI1JY0klOCOacDU6RqK1puj1nrTDK61LowJ-hPR05fgl2YRt0apUtKyJ9WLW4EUbzYuj2bw2bq-h-DiJhvKFeFSiFoX9Plf6CpuUiilKpTUgkuC2W9qASUBH7pY4tq9qJkriqkiStFCzf5Bldm6wdsYXOeL_cTh5dHBpphzct1djgSbfVuZfVuZQ1sV-NmfVblDf_VRAcgR-FHC7P4jZT5fz9lR9CdzgtRa</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Siroky, Gregory P.</creator><creator>Lee, Shawn</creator><creator>Suri, Ranjit</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><general>Wiley</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-8604-7218</orcidid></search><sort><creationdate>202012</creationdate><title>Shortness of breath and palpitations in an elderly man: Bad device behavior or malfunction?</title><author>Siroky, Gregory P. ; Lee, Shawn ; Suri, Ranjit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5646-b356cea5a1153fd961bf95cafa766386ac19c95767b7c4da356a8869f4529a5c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Atrial fibrillation</topic><topic>atrioventricular dyssynchrony</topic><topic>Conflicts of interest</topic><topic>ECG for Students & Assoc. Professionals</topic><topic>elective replacement indicator</topic><topic>Electrocardiogram</topic><topic>Electrocardiography</topic><topic>Heart</topic><topic>pacemaker syndrome</topic><topic>Pacemakers</topic><topic>Palpitation</topic><topic>Patients</topic><topic>permanent pacemaker</topic><topic>Sinuses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Siroky, Gregory P.</creatorcontrib><creatorcontrib>Lee, Shawn</creatorcontrib><creatorcontrib>Suri, Ranjit</creatorcontrib><collection>Wiley Online Library</collection><collection>Wiley Online Library Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Journal of arrhythmia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Siroky, Gregory P.</au><au>Lee, Shawn</au><au>Suri, Ranjit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Shortness of breath and palpitations in an elderly man: Bad device behavior or malfunction?</atitle><jtitle>Journal of arrhythmia</jtitle><addtitle>J Arrhythm</addtitle><date>2020-12</date><risdate>2020</risdate><volume>36</volume><issue>6</issue><spage>1109</spage><epage>1111</epage><pages>1109-1111</pages><issn>1880-4276</issn><eissn>1883-2148</eissn><abstract>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.</abstract><cop>Japan</cop><pub>John Wiley & Sons, Inc</pub><pmid>33335635</pmid><doi>10.1002/joa3.12446</doi><tpages>3</tpages><orcidid>https://orcid.org/0000-0002-8604-7218</orcidid><oa>free_for_read</oa></addata></record> |
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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 |
title | Shortness of breath and palpitations in an elderly man: Bad device behavior or malfunction? |
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