Pacing Spikes, No Capture

A 96-year-old woman develops Chest Pain days after pacemaker implantation. Her ECG shows pacing spikes but no capture. What’s the underlying rhythm?

Complete heart block


A 96-year-old woman presented to the emergency department with a 1-day history of pleuritic chest pain 4 days after a single-chamber transvenous pacemaker had been implanted. A chest radiograph and computed tomographic scan of the chest showed the tip of the right ventricular lead in the left pleural space. What rhythm does the electrocardiogram show?

What is the most likely diagnosis?

Atrial fibrillation
Complete heart block
Second degree heart block
Ventricular-paced rhythm
Wandering atrial pacemaker

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