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Case Reports
. 2021 Jan 20;3(1):146-149.
doi: 10.1016/j.jaccas.2020.10.030. eCollection 2021 Jan.

Intermittent Loss of Telemetry Data: Lessons From a Leadless Pacemaker

Dimitrios Katsaras  1 , Christopher Cassidy  1 , Mohammed Lakha  1 , Dawn Gordon  1 , Grahame Goode  1 , Khalid Abozguia  1
Affiliations
Case Reports

Intermittent Loss of Telemetry Data: Lessons From a Leadless Pacemaker

Dimitrios Katsaras et al. JACC Case Rep. .

Abstract

We present the case of a 63-year-old female patient who presented to the pacemaker clinic for a scheduled interrogation of her leadless pacemaker. The device interrogation was suggestive of intermittent under-sensing with failure to pace. Connecting the electrocardiogram lead to the pacing system analyzer raised the suspicion of intermittent loss of telemetry data. (Level of Difficulty: Beginner.).

Keywords: ECG, electrocardiogram; EGMs, electrograms; SVC, superior vena cava; bradycardia; cardiac pacemaker; electrocardiogram.

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Conflict of interest statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sector. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Device Interrogation Without Connected ECG Lead From top to bottom, this image shows the EGM channel, the marker channel, and the ECG channel (not connected). Circles indicate what seem to be T-wave-only EGMs (the 4th circle indicates the timing of the anticipated EGM), and solid arrows indicate the anticipated ventricular sensing markers, correspondingly, assuming a stable heart rate. Dashed arrows indicate the expected pacing spikes given a lower rate limit of 50 beats/min. ECG = electrocardiogram; EGM = electrogram.
Figure 2
Figure 2
Chest Radiograph Chest radiograph shows the position of the leadless pacemaker.
Figure 3
Figure 3
Device Interrogation With Connected ECG Lead (Top) The trace represents an intracardiac electrogram, whereas the second trace represents a pacemaker annotation. (Bottom) The trace represents an ECG, which shows sinus rhythm. Intermittent telemetry communication errors are demonstrated by the lack of EGM and ventricular sensing annotation corresponding to the 3rd QRS complex (A), artifact signal (B), autogain adjustment of the returned signal (C), a lack of ventricular sensing annotation, and distortion of the EGM corresponding to the 7th (D) and 8th QRS complexes (E). ECG = electrocardiogram; EGM = electrogram.
See this image and copyright information in PMC

References

    1. Kusumoto F.M., Schoenfeld M.H., Barrett C. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74:e51–e156. - PubMed

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