Apparent pacemaker malfunction due to ventricular blanking.

Electrocardiographic interpretation in patients with dual chamber pacemakers requires an intimate understanding of their manner of functioning. This report describes a patient whose pacemaker was suspected of malfunction because of failure to sense premature beats. This sense-failure resulted from the fortuitous concurrence of the sensed portion of the premature beat with the ventricular blanking period and was resolved by reducing the low rate limit of the pacemaker. Three principles must be recognized in interpreting suspected failure of sensing: 1. The channel of origin of the pacing artifact must be identified. 2. The surface QRS morphology does not necessarily correspond to the signal detected by the pacemaker. 3. Failure to sense does not necessarily equal pacemaker malfunction.