Failure to Pace (Oversensing) — ECG Academy Lesson

Recognize failure to pace (oversensing) — the pacemaker detects non-cardiac signals and inhibits inappropriately, failing to deliver stimuli when the patient needs them. Learn to identify absent pacemaker spikes, qualify pause urgency with facility policy, and close the module with a clean three-malfunction classifier.

Learning Objectives

• Define failure to pace (oversensing) and explain the underlying mechanism
• Identify the hallmark ECG pattern: absent pacemaker spikes when they should be present
• Explain how non-cardiac signals (EMI, T waves, myopotentials) cause inappropriate inhibition
• List the most common causes of oversensing
• Describe the appropriate monitor tech response to failure to pace
• Differentiate oversensing from failure to capture and failure to sense (undersensing)
• Apply a three-question classifier across all three pacemaker malfunctions