Electrocardiogram of a patient from “ECG Decoder – May, 2004” who presented to the ER one week after pacemaker implantation with intense, nearly constant precordial pain aggravated by movements and deep inspiration.

Interpretation: Abnormal ECG. Pacing activity at the rate of 72/min, neither capturing nor sensing. The ECG is otherwise similar to previous tracing.

On examination there was pericardial friction rub and stimulation of the intercostals muscles in the apical area, no clinical features of cardiac tamponade. It appeared that the pacing wire perforated free wall of the right ventricle with loss of capture and chest wall muscles stimulation. It was removed and repositioned uneventfully.

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