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JAMA Cardiology Clinical Challenge
June 3, 2020

An Unusual Electrocardiogram Following Pacemaker Implantation

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco, San Francisco
  • 2Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, California
JAMA Cardiol. 2020;5(7):843-844. doi:10.1001/jamacardio.2020.1061

A man in his 30s was incidentally found to have an abnormal electrocardiogram (ECG) result. Two years prior to presentation, the patient was presumptively diagnosed with viral myocarditis at an outside hospital after experiencing a ventricular fibrillation arrest. He was subsequently scheduled to undergo endomyocardial biopsy but was lost to follow-up. Two weeks prior to the date of the presenting ECG, he was admitted to the hospital for symptomatic bradycardia and found to be in sinus rhythm with complete atrioventricular block. A dual-chamber pacemaker was implanted, with active fixation leads placed in the right atrium and right ventricular apex. An ECG obtained immediately after the procedure showed an atrial-ventricular–paced rhythm. The postimplantation course was uncomplicated, and he was subsequently discharged. He presented for routine postprocedure outpatient follow-up, at which time this ECG (Figure 1) was obtained. His vital signs were documented as a blood pressure of 119/69 mm Hg, a heart rate of 51 beats per minute, a respiratory rate of 16 breaths per minute, and an oxygen saturation of 100% on room air. He was asymptomatic.

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