The ECGs of four patients with implanted dual chamber VDD and DDD PMKs are shown to demonstrate the difficulty of their interpretation and show some arrhythmias related to dual chamber pacing. In the first patient the DDD PMK caused a high ventricular frequency synchronizing on the atrial fibrillation "f" waves which occurred suddenly some time after PMK implantation; this problem was solved by programming the PMK in VVI. The second and third case, with implanted DDD and VDD PMK respectively, exemplify atrial sensing dysfunction due to atrial catheter displacement. In the fourth patient, with implanted VDD PMK, VDD stimulation periods and VVI ones alternated due to non-adjusted programming. Therefore, the paper re-emphasizes the need for accurate and periodic controls of patients with implanted PMK to correct dysfunction or undesirable patterns of stimulation.
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