Zusammenfassung A year-old woman was referred to our hospital because of dizziness and presumed pacemaker dysfunction Fig.
Eight weeks earlier, the patient had underwent implantation of a single chamber single chamber pacemaker medtronic Sensia, Medtronic, USA with a tined, steroid-eluting bipolar right ventricular RV lead CapSure Sense, Medtronic, USA for chronic atrial fibrillation and symptomatic bradyarrhythmia. Two weeks post-implantation surgical revision had been necessary due to RV lead dislocation.
Device interrogation prior to hospital discharge had been inconspicuous with a RV pacing threshold less than 1. Chest X-ray suggested a regular lead position in the RV apex.
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At presentation, the patient reported episodic dizziness and intermittent sharp left pectoral pain that was present since approximately 1 week. Device interrogation revealed a RV pacing threshold that had increased to[6 V at 1 ms during unipolar stimulation, with a pacing impedance of Ohms and an R wave amplitude sensing of[22 mV.
During bipolar stimulation, a pacing threshold of 2. On the same day, however, continuos ECG monitoring on the ward revealed intermittent loss of capture Fig.
Figure 5a shows the chest X-ray that was taken at the time the patient presented at our clinic. What is the most likely diagnosis?