Epicardial Unipolar Lead Loss of Ventricular Capture during Radiofrequency Ablation of Atrial Fibrillation

Introduction. Abnormal pacemaker behavior can occur during radiofrequency ablation. The behaviors are varied and include loss of capture. The mechanisms in this context have not been well described in the literature. We describe a case of epicardial unipolar lead loss of ventricular capture during pulmonary vein isolation. Case History. A 48-year-old man with an epicardial dual chamber pacemaker and persistent atrial fibrillation presented for radiofrequency ablation (RFA) of his abnormal rhythm. During RFA, intermittent loss of ventricular capture was witnessed. Review of the device settings prior to and after the procedure showed an increase in ventricular threshold after the procedure. Loss of capture was shown to be dependent on location and RF energy delivered. It was independent of QTc and independent of local cellular changes that would increase threshold. Conclusion. We hypothesize the mechanism of loss of ventricular capture in this patient with an epicardial pacemaker with unipolar leads is related to intermittent shunt of voltage from the pulse generator to the grounding pad rather than the unipolar lead.

Analysis of QRS complex recorded through a semiorthogonal lead system in the horse

A semiorthogonal lead system for recording electrocardiograms from horses was designed. The X, Y, and Z axes of the body were monitored by leads I, aVF, and V10 (the unipolar lead taken from the dorsal spinous process of the seventh thoracic vertebra), respectively. Records were taken from 15 standing horses. Ventricular premature beats were elicited by pricking foci on the right and left ventricular epicardium. For normally conducted beats, two major vectors represented forces generating the QRS complex. Vector 1, probably representing excitation of the apical third of the interventricular septum from left to right, was relatively low in magnitude, and was oriented dextrad, ventrad, and craniad. Vector 2, probably representing depolarization of the basilar third of the interventricular septum from left to right and in an apicobasilar direction, was of greater magnitude and was oriented ventrad, sinistrad, and craniad. Occasionally a vector intermediate between vectors 1 and 2 was oriented caudad and dorsad. The origin of this vector is equivocal. Left ventricular premature beats generated vectors of great magnitude oriented dextrad and craniad. Right ventricular premature beats generated vectors of magnitude between those of sinus or left ventricular origin, and directed predominantly sinistrad.