Yusuf Türkmen, Hacı Yusuf Güneş, Mustafa Yıldız, Cengizhan Türkoğlu

Keywords: Pacemaker replacement, fluoroscopy, complication, DDDR devices


A 32-year-old woman was referred to us for a routine pacemaker (PM) control procedure. A DDDR (dual chamber) PM was implanted in 2010 and an elective replacement indicator (ERI) alert was given 2 months and 21 days ago. Before battery replacement, a temporary PM lead was implanted through the right subclavian vein under the guidance of bedside echocardiography and the pacing threshold was found to be 1 Volt. When the ventricular lead of the permanent battery was removed from the generator, it resulted in cardiac arrest. On fluoroscopic view, the lead of the temporary PM was found in the right atrium. However, a wide QRS and a left bundle-branch block (LBBB) pattern rhythm was observed during a threshold test before the surgery. The activity of the atrium was sensed by the atrial lead of the permanent PM that worked on the atrial-sensed ventricular- (As/Vp) mode. Thus, there was a wide QRS and LBBB pattern and at the rate of equal to temporary PM's rate rhythm had been occurred during the threshold testing. In the absence of adequate intrinsic cardiac activity, if battery replacement is performed on DDDR-mode devices, the temporary PM lead must be implanted under fluoroscopic control and it must be ensured that it is in the ventricle.