Abstract| Volume 23, ISSUE 10, SUPPLEMENT , S33, October 2017

Kussmaul Sign Caused by Non-physiological VVI Pacing

      Case: A 72-year-old woman was hospitalized with dyspnea on exertion and edema. She had a history of surgical repair of atrial septal defect and a VVI pacemaker implantation for symptomatic sick sinus syndrome. Physical examination showed a sign of right heart failure: heaved motion of the internal jugular vein (V wave) during systole, and an increased central venous pressure on inspiration (Kussmaul sign). Electrocardiography revealed no apparent P wave with regular ventricular pacing rhythm of 80 bpm. Echocardiography showed preserved left ventricular ejection fraction with moderate tricuspid regurgitation. Right-sided heart failure was suspected and furosemide was administrated intravenously. Electro-physiological study revealed preserved ventriclo-atrial conduction, suggesting the presence of viable atrial myocardium. Additional atrial lead was inserted and AAI pacing was started. On physical examination, the V wave and the Kussmaul sign disappeared immediately after the procedure. Her symptom improved. Conclusions: Kussmaul sign observed after VVI pacemaker implantation suggested the presence of right-sided heart failure caused by both non-physiological pacing and ventriclo-atrial conduction.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Cardiac Failure
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect