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Tachycardia in the presence of a pacemaker
  1. S Menon,
  2. H Hafeez,
  3. T Verjee,
  4. R Sivakumar
  1. Department of Medicine, Lister Hospital, Stevenage, UK
  1. Correspondence to:
 Dr Sivakumar;

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Answers on p122.

A 84 year old woman was admitted with palpitations of a few days’ duration. She had a dual chamber permanent pacemaker (DDD) fitted five years ago for complete heart block. She was tachycardic with a heart rate of around 120 beats/min but haemodynamically stable. A rhythm strip is shown below (see fig 1).


  1. What is the electrocardiographic diagnosis?

  2. Is the pacemaker malfunctioning?

  3. How do you explain the tachycardia with pacing spikes?

  4. What is the differential diagnosis for tachycardia with pacing spikes?

  5. What is the management?

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