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Challenges in Clinical Electrocardiography
June 2015

A Case of Possible Pacemaker Undersensing

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
JAMA Intern Med. 2015;175(6):1050-1052. doi:10.1001/jamainternmed.2015.0174

A man in his 90s with a history of hypertension, hypercholesterolemia, sinus node dysfunction, and prior dual-chamber pacemaker implantation presented with 1 month of abdominal pain radiating to his back. The initial chest radiograph demonstrated a dual-chamber permanent pacemaker with an atrial lead in the right atrial appendage and ventricular lead at the right ventricular (RV) apex. A computed tomography angiogram demonstrated a 5.3 × 5.3-cm infrarenal abdominal aortic aneurysm with thrombus. The patient was urgently taken to the operating room for percutaneous endovascular aneurysm repair.

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