{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:08Z","timestamp":1753876268832,"version":"3.41.2"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T00:00:00Z","timestamp":1613606400000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Syncope in a patient with a pacemaker is a serious event requiring urgent action to ascertain its cause. Around 5% of cases are due to a pacemaker system malfunction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>An 82-year-old man underwent dual-chamber permanent pacemaker implantation due to intermittent high-degree atrioventricular block (AVB) in sinus rhythm. Nine months later, the patient reported episodes of syncope. The chest X-ray showed both leads to be at their expected positions. The electrocardiography (ECG) showed common atrial flutter. Ventricular capture during pacing in atrial demand pacing (AAI) mode confirmed cross-stimulation due to the switching of the atrial and ventricular leads at the pacemaker header.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Cross-stimulation is a rare possibility in a differential diagnosis of causes of syncope. The diagnosis is frequently made during the procedure or a few hours later. The lack of symptoms during 9 months in this case was likely due to the patient having normal sinus rhythm with preserved AV conduction most of the time, as well as ventricular capture from the atrial lead related to non-sensed P waves. When atrial arrhythmias occurred, the sensing of the F waves inhibited ventricular pacing. In order to avoid this complication, in patients with intermittent bradycardia, pacing at a slightly higher heart rate during implantation of the device should be recommended to see the chamber paced with the surface ECG connected to the device interrogator. The ECG and electrogram (EGM) should correlate during device interrogation in order to identify this complication.)<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab041","type":"journal-article","created":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T20:52:13Z","timestamp":1613854333000},"source":"Crossref","is-referenced-by-count":1,"title":["Syncope triggered by atrial flutter in a patient with a pacemaker: cross-stimulation\u2014a case report"],"prefix":"10.1093","volume":"5","author":[{"given":"Olga","family":"Dur\u00e1n-Bobin","sequence":"first","affiliation":[{"name":"Cardiac Arrhythmia Unit, Cardiology Department, Hospital Universitario Lucus Augusti, C\/Ulises Romero s\/n, 27003, Lugo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Crespo-Mancebo","sequence":"additional","affiliation":[{"name":"Cardiac Arrhythmia Unit, Cardiology Department, Hospital Universitario Lucus Augusti, C\/Ulises Romero s\/n, 27003, Lugo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana","family":"Elices-Teja","sequence":"additional","affiliation":[{"name":"Cardiac Arrhythmia Unit, Cardiology Department, Hospital Universitario Lucus Augusti, C\/Ulises Romero s\/n, 27003, Lugo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Gonz\u00e1lez-Juanatey","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario Lucus Augusti, Lugo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,2,18]]},"reference":[{"key":"2021021805084458400_ytab041-B1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/pace.12041","article-title":"Pacing system malfunction is a rare cause of hospital admission for syncope in patients with a permanent pacemaker","volume":"36","author":"Ofman","year":"2013","journal-title":"Pacing Clin Electrophysiol"},{"key":"2021021805084458400_ytab041-B2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.15420\/aer.2015.4.3.189","article-title":"Syncope in patients with pacemakers","volume":"4","author":"Sutton","year":"2015","journal-title":"Arrhythm Electrophysiol Rev"},{"key":"2021021805084458400_ytab041-B3","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1111\/j.1540-8159.2008.01078.x","article-title":"Pacemaker malfunction due to atrial and ventricular leads switched in the header: two faces of the same mistake?","volume":"31","author":"Jastrzebski","year":"2008","journal-title":"Pacing Clin Electrophysiol"},{"key":"2021021805084458400_ytab041-B4","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/S0377-1237(08)80124-4","article-title":"Case of dual chamber pacemaker with cross stimulation","volume":"64","author":"Bhardwaj","year":"2008","journal-title":"Med J Armed Forces India"},{"key":"2021021805084458400_ytab041-B5","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1111\/j.1540-8159.1985.tb05865.x","article-title":"Cross-stimulation: the unexpected stimulation of the unpaced chamber","volume":"8","author":"Levine","year":"1985","journal-title":"Pacing Clin Electrophysiol"},{"key":"2021021805084458400_ytab041-B6","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1111\/j.1540-8159.2011.03104.x","article-title":"Cross-stimulation due to malposition of an atrial lead of a dual-chamber pacemaker","volume":"35","author":"Sela","year":"2012","journal-title":"Pacing Clin Electrophysiol"},{"key":"2021021805084458400_ytab041-B7","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1111\/j.1540-8159.1990.tb02146.x","article-title":"Ventricular cross stimulation in a dual chamber pacing system: phenomenon analysis","volume":"13","author":"Puglisi","year":"1990","journal-title":"Pacing Clin Electrophysiol"},{"key":"2021021805084458400_ytab041-B8","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1111\/pace.12149","article-title":"Atrial and ventricular lead switch at the pacemaker header: why did asystole first occur 3 years later?","volume":"36","author":"Al Hamdi","year":"2013","journal-title":"Pacing Clin Electrophysiol"},{"key":"2021021805084458400_ytab041-B9","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.hrcr.2020.04.004","article-title":"An intriguing case of alternating bundle branch block pattern post dual-chamber pacemaker implant: unexpected complication during pacemaker implantation","volume":"6","author":"Agstam","year":"2020","journal-title":"HeartRhythm Case Rep"}],"container-title":["European Heart Journal - 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