Pacing spikes without visible QRS complexes: Failure to capture?
Antony Gonzales-Uribe, Malini Madhavan, Freddy Del-Carpio Munoz
✦ AI-curated · Sources linked
Case in brief
A man in his 60s with advanced infra-Hisian conduction disease received a dual-chamber pacemaker with left bundle branch area pacing. Post-implant telemetry showed intermittent pacing spikes without visible QRS complexes, raising concerns for lead dislodgment. However, the patient was asymptomatic, and device interrogation confirmed normal function. Further analysis revealed preserved T waves and low-amplitude ventricular depolarizations, attributed to telemetry processing artifact.
What made this case unusual
The case highlights telemetry processing artifact that mimicked failure to capture, despite preserved ventricular activation during unipolar pacing.
Diagnostic / clinical pearl
Clinicians should be aware that telemetry artifacts can obscure true cardiac activity, potentially leading to misinterpretation of pacing efficacy.
Why it matters
Understanding telemetry limitations is crucial for accurate assessment of pacemaker function and patient management.