Pacemaker Indication

History

The patient was a nonsmoker and enjoyed good health in the past. He had a history of new-onset dizziness and one episode of syncope. He was admitted to the hospital, and electrocardiogram (ECG) showed complete heart block with ventricular escape rate about 40 bpm. Clinically, he was not in heart failure, and echocardiography demonstrated normal left ventricular systolic function. Because there was no reversible cause, a dual-chamber pacemaker was implanted. The right ventricular lead was fixed at the right ventricular apex, and the right atrial lead was fixed at the right atrial appendage. The procedure was uneventful, and he was discharged.

One month after discharge, the patient reported a decrease in exercise tolerance and dyspnea.

Current Medications

The patient is on no medications.

Current Symptoms

The patient experienced a decrease in exercise tolerance and dyspnea.

Physical Examination

• BP/HR: 120/64 mm Hg/74 bpm, atrial sensing with ventricular pacing rhythm

• Height/weight: 170 cm/50 kg

• Neck veins: Mildly distended

• Lungs/chest: Fine crepitation over bilateral lung bases

• Heart: Normal heart sounds, no murmur

• Abdomen: Soft and nontender, no evidence of organomegaly

• Extremities: Warm and normal perfusion

Laboratory Data

• Hemoglobin: Within normal range

• Hematocrit/packed cell volume: Within normal range

• Mean corpuscular volume: Within normal range

• Platelet count: Within normal range

• Sodium: Within normal range

• Potassium: Within normal range

• Creatinine: Within normal range

• Blood urea nitrogen: Within normal range

Electrocardiogram

Chest Radiograph