Pacemaker is not sensing intrinsic activity, but fortunately, it’s also not capturing anything.
Seems to capture the first 3 beats, but then stops capturing (no P or QRS).
Not sensing what little intrinsic activity there is, but also not capturing anything.
It captures each paced beat, but does not fire, suggesting it sensed something that was not there – did it sense the one wave as a P or QRS and inappropriately inhibit?
The first pacer spike does not seem to capture, nor does the second. Then there are 2 pacer spikes way too close together, and the second spike seems to create (capture) a QRS complex. The cycle is repeated 5 beats later. I think this was a permanent internal VVI pacer that sensed the temporary transcutaneous pacer, even though the external pacer did not capture.
The fifth beat appears to be paced, as does the next one. Though hard to see spikes, it looks like all the rest are V-paced, as they have the wider QRS, suggesting they are not conducted via normal pathways. The big issue here is the drop in BP as the “atrial kick” is lost.
This is a rare, but fatal issue with telemetry. Beat 1 shows pacing beginning. Beat 46 shows a PVC followed by a pacing spike right in the T wave. It happens again in beats 48, 50 and 54. Although the spike is not visible, it happens again on beat 56, causing ventricular tachycardia/fibrillation.
The arrows are pointing out what are probably retrograde P waves, suggesting retrograde conduction. Could you just A-pace, have antegrade conduction and A-V synchrony?
Managed Ventricular Pacing (MVP)
Don’t underestimate the programming of permanent pacemakers. Some (like this one) will test every 24 hours to see if dual chamber pacing is still required, or if atrial pacing, or no pacing, will suffice. This device tried an Atrial pace, but there was no ventricular beat, so it reset and resumed A-V pacing. Confusing until the programming was reviewed – this might be misinterpreted as an A-pace with inappropriate sensing of a non-existent QRS.