Intermittent failure to capture: What is the mechanism?

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Intermittent failure to capture: What is the mechanism? Santosh K. Padala, MD, Parikshit S. Sharma, MD, MPH, Kenneth A. Ellenbogen, MD, FHRS, Jayanthi N. Koneru, MBBS HeartRhythm Case Reports Volume 2, Issue 2, Pages 178-182 (March 2016) DOI: 10.1016/j.hrcr.2016.01.006 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: Baseline paced electrocardiogram. Electrocardiogram shows atrial sensed ventricular paced rhythm with a very wide complex tachycardia (QRS duration of 240 milliseconds) at 115 beats per minute with group beating due to intermittent failure to capture. Note, the width of the QRS complex gradually increases such that the last QRS complex before the pause is much wider than the first QRS after the pause. B: Intracardiac electrogram. Atrial sensed ventricular paced rhythm with intermittent failure to capture. HeartRhythm Case Reports 2016 2, 178-182DOI: (10.1016/j.hrcr.2016.01.006) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 A: Baseline nonpaced electrocardiogram shows atrial fibrillation with a wide complex QRS measuring 200 milliseconds. B: Nonpaced electrocardiogram recorded after 48 hours. The electrocardiogram shows atrial fibrillation with QRS measuring 136 milliseconds. HeartRhythm Case Reports 2016 2, 178-182DOI: (10.1016/j.hrcr.2016.01.006) Copyright © 2016 Heart Rhythm Society Terms and Conditions