Establishing Pacemaker Dependence the Hard Way

Report:

Sinus rhythm 1

Third degree AV block 3

Idioventricular rhythm 2

QT interval 0.86” 1

Sinus arrest 2

Pacemaker rhythm 1

Comment:

The surgeon, who got rather flustered when told the heart had stopped, certainly established the diagnosis of this patient’s absolute dependence on a pacemaker. The anaesthetist, equally flustered and even less familiar with the procedures, welcomed the arrival of the permanent pacemaker rhythm by saying he preferred the “one he had before”! Presumably the idioventricular beats looked more normal and reassuring to him.

This was in bad old days. Great majority of permanent pacemaker implantations are now performed by Cardiologists.

Fig 54. 51 year old man dying from multi-organ failure following cardiac arrest at home. A temporary pacemaker is in place.

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