8. Pacemaker Indication

Published on 02/03/2015 by admin

Filed under Cardiovascular

Last modified 02/03/2015

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The patient was a nonsmoker and enjoyed good health in the past. He had a history of new-onset dizziness and one episode of syncope. He was admitted to the hospital, and electrocardiogram (ECG) showed complete heart block with ventricular escape rate about 40 bpm. Clinically, he was not in heart failure, and echocardiography demonstrated normal left ventricular systolic function. Because there was no reversible cause, a dual-chamber pacemaker was implanted. The right ventricular lead was fixed at the right ventricular apex, and the right atrial lead was fixed at the right atrial appendage. The procedure was uneventful, and he was discharged.
One month after discharge, the patient reported a decrease in exercise tolerance and dyspnea.

Current Medications

The patient is on no medications.

Current Symptoms

The patient experienced a decrease in exercise tolerance and dyspnea.


It is likely new-onset heart failure symptoms occurred after device implantation.

Physical Examination

Laboratory Data



Atrial sensing and ventricular pacing rhythm, dependent pacing rhythm.


The ECG showed dependent pacing rhythm.

Chest Radiograph


The chest radiograph did not show any abnormalities.


It is necessary to rule out pulmonary disease and see any evidence of congestive heart failure.


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