Inappropriate spikes on telemetry?
This 81-year old patient with a dual chamber pacemaker (implanted in 2015 for sick sinus syndrome) was admitted because of chest pain for which he will receive coronary angiography.
This strip of ECG telemetry was printed because it caught the attention of the attending nurse (see circles drawn on the stip).
What do you think is happening? Is it normal pacemaker behaviour? Which brand pacemaker is this?