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A Case of Pacing Failure Associated with Postural Change Satoshi Kaimoto 1 , Hirokazu Shiraishi 1 , Takeshi Shirayama 1 , Akira Kuroyanagi 1 , Takeshi Nakamura 1 , Tetsuhiro Yamano 1 , Akiyoshi Matsumuro 1 , Takahisa Sawada 1 , Hiroaki Matsubara 1 1Department of Cardiology and Vascular Medicine, Kyoto Prefectural University of Medicine Keyword: ペーシング不全 , 体位 , キャプチャーマネージメント , pacing failure , posture , capture management pp.873-878
Published Date 2012/8/15
DOI https://doi.org/10.11477/mf.1404102031
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 A 63-year-old woman who had undergone mitral valve replacement for mitral valve stenosis, received a VVI pacemaker implantation for atrial fibrillation with slow ventricular response. The screw-in lead was located at the right ventricular septum. Five years later, she was admitted again for a generator exchange without symptoms. Though the pacing output was set as 3.0V/0.4msec after the operation, the electrocardiographic monitor showed pacing failure during sleep in the right lateral position. Telemetry data showed fluctuation of threshold due to postural change;the threshold was 0.75V/0.4msec in the supine position, 0.75V/0.4msec in the left lateral position, but 1.5V/0.4msec in the right lateral position. The X-ray showed the decrease of lead flexure in the right lateral position. The possible mechanism of fluctuation of the pacing threshold was the minimal change of lead contact the ventricle and the traction force by tricuspid valve regurgitation. Clinicians should recognize the possibility of pacing failure due to postural change.


Copyright © 2012, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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