Late presentation of recurrent syncope after permanent pacemaker implantation due to Lead−Header malapposition

Permanent pacemaker (PPM) malfunction due to electrical connection problems such as a loose set screw or lead-header malapposition is extremely rare. We present a patient with complete heart block (CHB) who had PPM malfunction and recurrent syncope, late (14 months) after initial implantation, which was caused by the ventricular lead pin disengagement from the header resulting in oversensing due to noise, pacing inhibition and recurrent syncope. PPM due to lead-header malapposition this late after device implantation has previously not been reported.     

S-ICD oversensing detected by remote monitoring using a new atrial fibrillation diagnostic algorithm

A 64-year-old male with a high body mass index, and subcutaneous implantable cardioverter defibrillator, (S-ICD) presented with a remote transmission of inappropriately diagnosed AF episodes, due to oversensing of P and T waves. The AF monitor can be an early warning for inappropriate sensing. Oversensing, due to small amplitude signals, can be caused by the lead position not being adequately opposed to the sternum.     

Inhibition of ventricular output in a dual chamber pacemaker with normal pacing and sensing parameters: What is the mechanism?

A 65-year-old gentleman with dual chamber pacemaker presented with presyncope. The ECG raised concerns of oversensing which was confirmed by magnet response. The device interrogation revealed noise in ventricular channel temporally associated with P wave. The pacing thresholds were normal. Although the ventricular lead impedance was within normal limit the impedance trend suggested 100 Ω decline over last 1 year. RV lead insulation failure was speculated and supported by the bipolar and unipolar intracardiac electrogram. Device was programmed to DOO temporarily. He underwent RV lead replacement uneventfully.     

Unexpected inhibition of bradycardia pacing due to oversensing in ICD lead fracture associated with spurious tachyarrhythmia detection and discharges

Ιn a 76-year old man with a dual-chamber ICD implanted five years ago, dizzy spells and significant bradycardia on Holter were not initially recognized as inhibition of bradycardia pacing, due to oversensing. Hospital admission was deemed necessary only after repetitive ICD shocks attributed to right ventricular pace-sense lead fracture. The need to ensure adequate ICD antibradycardia backup pacing in pacing-dependent patients when deleterious sensing errors occur, cannot be overemphasized.