Paced Rhythms

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    77 year old male with a left subclavicular scar.

    77 year old male with a left subclavicular scar.

    Key Findings

    - Atrial paced rhythm

    - Algorithmic pacing 

    Coding for the Boards

    - Sinus rhythm 

    - Prominent U waves

    Answers

    Discussion: The lack of proper pacemaker diagnostic codes on the ABIM coding sheet is highlighted here. This is a normally functioning pacemaker that is intermittently pacing the ventricle in response to a PAC due to ventricular based timing rules. If a ventricular sensed event is not sensed within a given interval it will pace the ventricle at the expense of the AV delay.