Triple pacing spikes on QRST: What is the mechanism?

Sudipta Mondal; N Sharath; Jyothi Vijay; Narayanan Namboodiri

doi:10.1016/j.jelectrocard.2024.153849

Triple pacing spikes on QRST: What is the mechanism?

J Electrocardiol. 2025 Jan-Feb:88:153849. doi: 10.1016/j.jelectrocard.2024.153849. Epub 2024 Dec 7.

Authors

Sudipta Mondal¹, N Sharath¹, Jyothi Vijay¹, Narayanan Namboodiri²

Affiliations

¹ Department of Cardiology, Electrophysiology division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India.
² Department of Cardiology, Electrophysiology division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India. Electronic address: [email protected].

PMID: 39667154
DOI: 10.1016/j.jelectrocard.2024.153849

Abstract

A septuagenarian man underwent dual chamber pacemaker (DDDR - Boston Scientific Massachusetts, U.S.) insertion for a complete heart block. Intra-procedural lead parameters were within normal limits. Frequent multisite origin premature ventricular complexes were noted even on pre-procedural electrocardiogram (ECG). On the follow-up ECG one pacing spike on the QRS of the first beat was followed by two pacing spikes on the T wave with a total of three pacing spikes on the whole QRST of the first complex. What is the mechanism?

Keywords: Backup pulse; PaceSafe; RV automatic capture; RVAC; Triple pacing spikes.

Publication types

Case Reports

MeSH terms

Cardiac Pacing, Artificial* / methods
Diagnosis, Differential
Electrocardiography*
Heart Block / physiopathology
Humans
Male
Pacemaker, Artificial
Ventricular Premature Complexes / diagnosis
Ventricular Premature Complexes / physiopathology