When using a transcutaneous pacemaker, it is important to remember that the pacing stimulus can cause an artifact on the ECG. This artifact is sometimes confused for a QRS complex. Also, the pacing of the chest wall muscles can be misinterpreted as
Failure to capture
This ECG is taken from a patient with an implanted pacemaker who was experiencing near-syncope. She was taken to the hospital by EMS, where the pacemaker was adjusted to obtain ventricular capture. This ECG did not have a Lead II rhythm strip, so the 12-lead ECG is being presented. The P waves have been marked with a "P", pacemaker spikes marked with an arrow, and the QRS complexes marked with a "J" because they are junctional.
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