Pacemaker rhythm or LBBB?
Report:
Sinus rhythm 87/min 2
Atrial-sensing ventricular pacemaker 8
Comment:
The point here is how small the pacing spikes are; they are best seen in L2 and V4, starting small shallow R waves in the latter. I was ready to cross the computer report and write LBBB instead, but something made me look again.
The QRS morphology does not help much. In V1, the QRS descent is not slurred or delayed (see Case 44), as would be expected in RV ectopic or RV-paced beats. On the other hand, its onset is a little delayed compared to the leads below it. One possibility is that there was ventricular fusion throughout between the patient’s native complexes (she had normal conduction before pacemaker implantation) and the ventricular paced ones.
See also Cases 15 and 94.
The Fig 41a below is easier to interpret.
Fig 41a. the spikes in V4 and now V5 are more visible.
Fig 42. 73 year old man in ICU following CABGs.
If you have any suggestions for or feedback on this report, please let us know.
Hi, can we chat about some terms and conditions?
The library and its records are licensed under the Creative Commons Attribution 4.0 International license.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
By clicking agree below, you are agreeing to adhere to CC BY 4.0.