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A.C. Lindsay, T. Wong, O. Segal, N.S. Peters, An unusual twist: ventricular tachycardia induced by a loop in a right ventricular pacing wire, QJM: An International Journal of Medicine, Volume 99, Issue 5, May 2006, Pages 347–348, https://doi.org/10.1093/qjmed/hcl043
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Sir,
An 80-year-old lady presented to our Accident and Emergency department with episodes of recurrent syncope that were preceded by shortness of breath, but no chest pain or palpitations. She had a past history of ischaemic heart disease and complete heart block, for which a dual-chamber pacemaker had been inserted 4 months previously. All the episodes of syncope had occurred following pacemaker implantation, and a Holter monitor had been fitted to investigate them.
On examination, her heart rate was 70 bpm and regular. She exhibited signs of heart failure; jugular venous pressure was raised and bilateral crepitations were heard at the lung bases. Chest X-ray confirmed pulmonary oedema ( Figure 1 ), but the penetration of the study did not allow us to visualize the pacing lead within the cardiac silhouette. An ECG at the time showed an atrial sensed and ventricular paced rhythm. Cardiac troponin I was raised, at 1.8, but the biochemical profile and thyroxine level were normal. A pacemaker check revealed the pacemaker was functioning appropriately. The patient's heart failure responded well to medical management with frusemide and nitrates.
