Paced Rhythms

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    66 year old female who is 2 days post an aortic valve replacement.

    66 year old female who is 2 days post an aortic valve replacement.

    Key Findings

    -Ventricular pacing with failure to sense and functional noncapture 

    Coding for the Boards

    -Sinus rhythm

    -Left atrial abnormality

    -Left bundle branch block

    -Pacemaker malfunction, not constantly sensing

    Answers

    Discussion: There is occasional failure to capture here, but this is functional noncapture due to the stimulus being delivered during the ventricular refractory period. The key abnormality is that the pacemaker is failing to sense. This is a VOO epicardial pacing wire.