tag:blogger.com,1999:blog-18943510.post6083869555387373236..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: EKG Du Jour - # 8: The Case of Abdominal PainDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-18943510.post-28998705580279649782008-06-02T15:36:00.000-05:002008-06-02T15:36:00.000-05:00Without knowing the underlying pacing mode and som...Without knowing the underlying pacing mode and some other data (make, model of device, programmed rate) it is not possible to do anything but guess, however I agree it is oversensing on the ventricular channel. You say the pt was implanted with a bipolar lead. My guess is that you have an insulation failure and the resultant interference caused by an intermittentint connection between the two Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-84091753552857025342008-05-29T18:00:00.000-05:002008-05-29T18:00:00.000-05:00RW-This pt had paroxysmal atrial fibrillation at t...RW-<BR/><BR/>This pt had paroxysmal atrial fibrillation at the time of the initial AVJ ablation/pacer in 2001 (hence why the atrial lead was necessary) which became chronic as the years progressed.DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-65420265837363341852008-05-29T11:39:00.000-05:002008-05-29T11:39:00.000-05:00Very interesting. Although of no immediate releva...Very interesting. Although of no immediate relevance to the patient's problem I would have asked the internist "with hope of achievement and maintanance of sinus rhythm presumably abandoned, why a dual chamber pacer following AV node ablation?"Robert W Donnellhttps://www.blogger.com/profile/16944231400440786271noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-32621988992420342752008-05-28T22:23:00.000-05:002008-05-28T22:23:00.000-05:00This EKG demonstrates evidence of oversensing by t...This EKG demonstrates evidence of <I>oversensing</I> by the pacemaker with subsequent inhibition of pacing (Note: there is no pacing spikes seen during the pauses on the EKG. As such, this represents a problem with sensing of the possible intrinsic ventricular activity by the pacemaker, rather than a loss of output from the pacemaker.)<BR/><BR/>Oversensing occurs when signals are received by theDrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-27924980092992807432008-05-28T20:53:00.000-05:002008-05-28T20:53:00.000-05:00I am not a specialist but can't a wire break and m...I am not a specialist but can't a wire break and migrate down the drain ? That would cause pain.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-60277683062218647832008-05-28T20:06:00.000-05:002008-05-28T20:06:00.000-05:00Hmm, I'm not sure how to relate the device malfunc...Hmm, I'm not sure how to relate the device malfunction to her LLQ abdominal pain. The lead could have perforated, however, when this occurs you typically see failure to capture (pacing spikes with no QRS complexes). Could the lead have perforated and be intermittently oversensing the diaphragmatic stimulation (hence the group beating with respirations)? Seems pretty unlikely. Other causes of Ablate This!https://www.blogger.com/profile/03835353799229337582noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-7699437917061217482008-05-28T09:37:00.000-05:002008-05-28T09:37:00.000-05:00at-While I'll spot you oversensing (the pacer inhi...at-<BR/><BR/>While I'll spot you oversensing (the pacer inhibiting its output based on a sensed signal), the interval from the last paced beat to the next pacer output exceeds the expected interval from any portion of the preceeding T wave, hence this pacer inhibition cannot be from simple T wave oversensing.<BR/><BR/>Hmmmm. How might this finding have contributed to the patient's symptoms of DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-72213842128988471932008-05-27T22:21:00.000-05:002008-05-27T22:21:00.000-05:00T wave oversensing. Reduce the sensitivity on the...T wave oversensing. Reduce the sensitivity on the ventricular lead and she'll stop inhibiting and passing out.Ablate This!https://www.blogger.com/profile/03835353799229337582noreply@blogger.com