Pacemaker Stimulation Criticism at ECG

  • Paolo Bonelli
  • Giorgio Guidotti
  • Enrico Paolini
  • Giulio Spinucci


Cardiac implantable electronic devices’ (CIEDs) numbers have grown up worldwide over the last years [1]. At the same time, functions and algorithms’ complexity implementation also expanded. It will be therefore more and more frequent for the clinician to deal with pacemaker (PM) ECGs and unusual device behaviors, particularly when they mimic pseudo-malfunctions. In this chapter, we present some examples of challenging electrocardiograms, aiming to show how the clinician, just by analyzing the ECG, could reach or at least suspect the correct diagnosis.


  1. 1.
    Arribas F, Auricchio A, Boriani G, et al. Statistics on the use of cardiac electronic devices and electrophysiological procedures in 55 ESC countries: 2013 report from the European Heart Rhythm Association (EHRA). Europace. 2014;16:i1–78.CrossRefGoogle Scholar
  2. 2.
    DAVID Trial Investigators. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the dual chamber and VVI implantable defibrillator (DAVID) trial. JAMA. 2002;288:3115–23.CrossRefGoogle Scholar
  3. 3.
    Mulpuru SK, Madhavan M, Mcleod CJ, et al. Cardiac pacemakers: function, troubleshooting, and management. J Am Coll Cardiol. 2017;69(2):189–210.CrossRefGoogle Scholar
  4. 4.
    Bastian D, Fessele K. Strategies and pacemaker algorithms for avoidance of unnecessary right ventricular stimulation. In: Roka A, editor. Current issues and recent advances in pacemaker therapy. London: InTech; 2012. Available from Scholar
  5. 5.
    Lloyd MS, El Chami MF, Langberg JJ. Pacing features that mimic malfunction: a review of current programmable and automated device functions that cause confusion in the clinical setting. Cardiovasc Electrophysiol. 2009;20(4):453–60.CrossRefGoogle Scholar
  6. 6.
    Hermosura T, Bradshaw WT. Wolff-Parkinson-White syndrome in infants. Neonatal Netw J Neonatal Nurs. 2010;29(4):215–23.CrossRefGoogle Scholar
  7. 7.
    Gregg RE, Zhou SH, Dubin AM. Automated detection of ventricular pre-excitation in pediatric 12-lead ECG. J Electrocardiol. 2016;49(1):37–41.CrossRefGoogle Scholar
  8. 8.
    Garg N, Moorthy N. Inadvertent temporary pacemaker lead placement in aortic sinus. Heart Views. 2013;14(4):182–4.CrossRefGoogle Scholar
  9. 9.
    García-Bengochea J, Rubio J, Sierra J, Fernández A. Pacemaker migration into the pouch of Douglas. Texas Hear Inst J. 2003;30(1):83.Google Scholar
  10. 10.
    Reade MC. Temporary epicardial pacing after cardiac surgery: a practical review part 1. Anaesthesia. 2007;62(3):264–71.CrossRefGoogle Scholar
  11. 11.
    Reade MC. Temporary epicardial pacing after cardiac surgery: a practical review part 2. Anaesthesia. 2007;62(4):364–73.CrossRefGoogle Scholar
  12. 12.
    Timperley PL, Mitchell ARJ, et al. Oxford specialist handbooks in cardiology: pacemakers and ICDs. Oxford: Oxford University Press; 2008. p. 104–5.Google Scholar
  13. 13.
    Safavi-Naeini P, Saeed M. Pacemaker troubleshooting: common clinical scenarios. Tex Heart Inst J. 2016;43(5):415–8.CrossRefGoogle Scholar
  14. 14.
    Haghjoo M. Pacing system malfunction: evaluation and troubleshooting. In: Das MR, editor. Modern pacemakers - present and future. London: InTech; 2011. ISBN: 978-953-307-214-2. Available from: Scholar
  15. 15.
    Marx J, Walls R, Hockberger R. Rosen’s emergency medicine: concepts and clinical practice. 7th ed. Philadelphia: Mosby/Elsevier; 2013. p. 1027–32.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Paolo Bonelli
    • 1
  • Giorgio Guidotti
    • 1
  • Enrico Paolini
    • 1
  • Giulio Spinucci
    • 1
  1. 1.Clinica di Cardiologia e AritmologiaOspedali Riuniti di Ancona, Università Politecnica delle MarcheAnconaItaly

Personalised recommendations