A nurse is caring for a patient who has a temporary transvenous cardiac pacemaker following an inferior wall myocardial infarction. On the cardiac telemetry monitor, the nurse notes pacing spikes that are NOT followed by QRS complexes. What pacemaker malfunction does this rhythm strip represent?

Answer and explanation

Correct answer: D. Failure to capture

  1. Step 1: Failure to capture occurs when the pacemaker generates an electrical pacing spike, but the stimulus is of insufficient amplitude or timing to depolarize the myocardial tissue.
  2. Step 2: This manifests on the ECG as pacemaker spikes that are not followed by corresponding P waves (atrial pacing) or QRS complexes (ventricular pacing).
Answer
Failure to capture.
Why not the others: 'Failure to pace' occurs when the pacemaker fails to fire a spike when programmed to do so (absence of pacing spikes); 'Failure to sense' occurs when the pacemaker fails to recognize the patient's intrinsic rhythm and fires inappropriately into T waves; 'Oversensing' occurs when the device misinterprets muscular signals as heartbeats and inappropriately inhibits pacing.

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