ECG 1. How do isolated pacemaker spikes appear? This ECG was recorded after an unsuccessful resuscitation attempt.
Although there is no cardiac contraction the pacemaker still continues to give
pacemaker spikes which do not result
in cardiac contraction. This ECG was recorded just after the death of a patient with advanced heart failure who was implanted
a permanent cardiac pacemaker one year ago.

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ECG 2. Blue arrows show the vertical pacemaker spikes preceding the QRS complexes in a patient with VDD.

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ECG 3. In pacemakers with bipolar electrodes, the pacemaker spikes may be difficult to recognize at first glance.
Spikes are seen in leads C4, C5 and C6.

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ECG 4. DDD (double chamber pacemaker) ECG.
Red arrows show the spikes resulting in atrial stimulation. Blue arrows show
the spikes resulting in ventricular stimulation.

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ECG 5.
Red arrows show ventricular premature systole (VPS) in a patient with permanent pacemaker.
Blue arrows show pacemaker spike stimulating the ventricles.

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ECG 6. The ECG above belongs to a 65 years-old woman with a normal functioning DDDR type pacemaker.

Baseline drift
should not be misdiagnosed as pacemaker dysfunction.

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ECG 7. Pace dysfunction.
Blue arrows show the spikes which successfully resulted in ventricular stimulation. Red arrows
show the spikes (pacing dysfunction) which did not succeed in depolarizing the ventricles.
Green arrows show the ventricular escape rhythm.

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ECG 8. Atrial flutter in a patient with permanent pacemaker.
Red arrows show the flutter waves.

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ECG 9. Red arrows show the
normally conducted impulses, blue arrows show the pacemaker induced ventricular
depolarizations
. The green arrow shows the fusion beat.

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ECG 10. VDD pacemaker.
P waves have no preceding pacemaker spikes since this type of pacemaker follows the atria
but
stimulates only the ventricles (arrows). This ECG is from a 70 years-old woman.

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