by Luke Cunningham, MD, and Yochai Birnbaum, MD
An 81-year-old woman with a
medical history of coronary artery disease, paroxysmal atrial fibrillation, and
sick sinus syndrome, and implantation in 2013 of an AltruaTM dual-chamber pacemaker (Boston
Scientific Corporation; Natick, Mass), presented after device interrogation
revealed elevated impedance of >2,500 Ω in her atrial lead. The device
settings were DDD mode, a lower rate limit of 60 beats/min, and a maximum atrioventricular
(AV) delay of 330 ms. She reported fatigue, dyspnea on exertion, and occasional
palpitations. She was admitted for new atrial lead implantation, and an
electrocardiogram was obtained (Fig. 1).
