Pacemaker interrogation

[prolene60]

Had an 80 yo male yesterday with history of a fib/flutter. Had a dual pacemaker also. Presented with what looked like a fib vs flutter with hr in 140s. Patient hypotensive in 60s. Ultimately cardioverted with immediate normalization of heart rate now in paced rhythm. BP now stable. The PCM interrogation showed no events. I’m really confused and looked at the report in detail and there is no recording of any AT/AF episodes. I’m just trying to understand the report. Either I was hallucinating at the bedside cardiac monitor showing a fib or is there a possibility the PCM wouldn’t necessarily pick up an atrial tachycardia 100% of the time? Any help would be appreciated.

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[southerndoc]

He probably never met threshold for the rate (may have it set to 150).

 

[Zebra Hunter]

I wouldn’t trust a cardiac monitor interpretation alone, could have just as easily been sinus arrhythmia. I always get a 12 lead on patients I’m about to shock as long as they are still alive.

Also, afib with a HR of 140 is pretty atypical to cause marked hypotension. Certainly possible, but along with a lack of interrogation proven event, I think it’s just as possible you shocked something other than afib/flutter.

Sounds like a good outcome regardless.

 

[turkeyjerky]

I had a lady with an ectopic atrial tachycardia the other day where the PM interrogation was normal w/o events. I agree w/ Southern, I think the device protocol has something to do w/ the rate so that an atrial flutter will be misread as sinus if below threshold.

 

[greatnt249]

Had an 80 yo male yesterday with history of a fib/flutter. Had a dual pacemaker also. Presented with what looked like a fib vs flutter with hr in 140s. Patient hypotensive in 60s. Ultimately cardioverted with immediate normalization of heart rate now in paced rhythm. BP now stable. The PCM interrogation showed no events. I’m really confused and looked at the report in detail and there is no recording of any AT/AF episodes. I’m just trying to understand the report. Either I was hallucinating at the bedside cardiac monitor showing a fib or is there a possibility the PCM wouldn’t necessarily pick up an atrial tachycardia 100% of the time? Any help would be appreciated.

The atrial rate probably didn't meet the programmed threshold to flag as abnormal or trigger a mode switch in the pacemaker.

 

[WilcoWorld]

Had an 80 yo male yesterday with history of a fib/flutter. Had a dual pacemaker also. Presented with what looked like a fib vs flutter with hr in 140s. Patient hypotensive in 60s. Ultimately cardioverted with immediate normalization of heart rate now in paced rhythm. BP now stable. The PCM interrogation showed no events. I’m really confused and looked at the report in detail and there is no recording of any AT/AF episodes. I’m just trying to understand the report. Either I was hallucinating at the bedside cardiac monitor showing a fib or is there a possibility the PCM wouldn’t necessarily pick up an atrial tachycardia 100% of the time? Any help would be appreciated.

It'd be pretty cool if you posted a (de-identified) rhythm strip or ECG for us to nerd out over.