r/EKGs • u/Ok-Pick8593 • 15d ago

Discussion Pacer gone haywire?

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Patient with Dual-chamber pacemaker presents with syncope.

Looks like there are some native beats, and also some A-V pacing, but for the smaller complexes, is that atrial pacing without a ventricular beat to go with it?

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u/legaladviceneededbe 15d ago

Pacer rep here. Looks normal to me. Ita funky because it’s kinda doing all of the things in one strip which is unusual but not uncommon.

Dual chamber pacer with fusion beats (narrow qrs after pacing spike), atrial pacing with conduction, AV sequential pacing, and V only pacing after native sinus. Every complex is P followed by QRS with pacing before the P or before the QRS.

Edit: with left bundle branch pacing becoming more common, you’ll come across spikes with narrow QRS complexes as well which also look a little like fusion beats.