An Electrocardiographic Artifact Mimicking Pacemaker Malfunction

CASE SUMMARY: A patient presents with symptomatic bradycardia and high-grade atrioventricular block and receives a dual-chamber pacemaker with left bundle branch area pacing lead. Post procedure, there is concern for dislodgement of the ventricular lead after an electrocardiogram shows a missing ventricular paced beat. After additional device interrogation and review of the device manufacturer algorithms, it was determined that what was thought to be loss-of-capture or loss-of-sensing was coincidental artifact and normal device function. TAKE-HOME MESSAGES: The highest risk for pacemaker lead dislodgement is immediately after implantation, and a 12-lead electrocardiogram should be reviewed post implantation. Understanding device manufacturer algorithms can help interpret unusual artifacts and findings in paced rhythms.