A Shifting Pacemaker: Artifact or Ischemia?

Excerpt

An 85-year-old woman with a history of ischemic cardiomyopathy, single-vessel coronary artery bypass grafting (left internal mammary artery-left anterior descending artery), percutaneous coronary stenting of the right coronary artery, paroxysmal atrial fibrillation, and biventricular pacemaker-defibrillator was admitted to our hospital with acute decompensated heart failure, her third hospitalization in twelve months. Electrocardiogram revealed an atrial-sensed, ventricular-paced rhythm (Fig. 1). Echocardiogram demonstrated a severely dilated left ventricle with an ejection fraction of 30% and akinesis of the mid and distal anteroseptum, mid and distal anterior wall, mid and distal lateral wall, and apex as well as hypokinesis of the inferior wall; this was unchanged from prior.

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