Agonal Pacemaker Rhythm
Report:
Pacemaker rhythm 80/min 4
Broad pacemaker complexes 0.36” suggest hyperkalæmia or agonal rhythm 6
Comment:
It was the latter – agonal rhythm. I rang the patient’s physician who told me the patient had by then been allowed to die, in cardiogenic shock from end-stage ischæmic cardiomyopathy. Hyperkalæmia was probably present as well. There is an almost perfect “sine curve” in the rhythm strip.
In V1-2, the pacing spike appears well removed from the onset of the QRS, due to a large isoelectric segment.
A trace taken a fortnight previously is shown below (Fig 35a).
See also Case 67.
Fig 35a. Broad but still acceptable paced QRS complexes. The pacemaker sensed the VEB.
Fig 36. 73 year old man with a permanent pacemaker.
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