Key result
In an 80-year-old woman with a VDD-pacemaker, AV-synchrony of 58-73% was maintained despite displacement of the atrial dipole into the right ventricular outflow tract.
Case Report (n=1)
This case report highlights that AV-synchrony can be partially maintained by left atrial sensing when a VDD pacemaker's atrial dipole is displaced into the right ventricular outflow tract.
Case of preserved AV synchrony with malpositioned VDD dipole is hypothesis-generating; does not support altering lead management.
The case of an 80-year-old woman who underwent permanent VDD-pacemaker implantation for recurrent syncope in the presence of second-degree type 2 AV-block is reported. During follow-up, low atrial sensing with AV-synchrony of only 58-73% was noted. Four years after the pacemaker implantation, the patient was hospitalized for non-cardiac reasons and the chest radiograph showed displacement of the atrial dipole into the right ventricular outflow tract (RVOT). It is hypothesized that AV-synchrony was maintained by left atrial sensing due to the anatomic proximity of the RVOT to the left atrial appendage.
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Schumann et al. (2007) conducted a case report in Recurrent syncope with second-degree type 2 AV-block (n=1). VDD-pacemaker implantation was evaluated on AV-synchrony. In an 80-year-old woman with a VDD-pacemaker, AV-synchrony of 58-73% was maintained despite displacement of the atrial dipole into the right ventricular outflow tract.
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