Reversed Atrial & Ventricular Electrodes

Report:

Sinus rhythm (non-conducted) 1

Pacemaker rhythm 78/min 1

Reversed A & V leads 5

Intermittent atrial captures with 1o AV block & IVCD (unspecified) 3

Comment:

This was a prank by a junior colleague, in this case harmless, but interesting. The ventricle is paced first, through what the unit thinks is the atrial electrode. Atria are paced next, with some distortion of the ensuing T wave indicating P waves; a few are even conducted, with 1o AV block and, possibly, aberrant conduction.

Fig 50. 75 year old lady with permanent pacemaker. What conduction defects preceded its implantation?

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