Another Lead 2 Problem: Narrow Pacemaker Escapes

Report:

Sinus bradycardia 38/min

Left atrial abnormality

Pacemaker escape beats

Escape-capture bigeminy

ST/T changes c/c ischæmia

Comment:

Lead 2 rhythm strip (misprinted as lead 1 – we had a machine that always did it) shows narrow paced beats at some distance from their pacing spikes; the interval between the two looks like a baseline drift from the large, unipolar, spike. Elsewhere the paced QRS starts obviously from the spike and is broad enough to have the expected (for RV apical electrode) LBBB/LAD morphology.

There is much to be said for using modified V1 (Marriott lead) for rhythm strips.

288. Stocky 82 year old man on verapamil for chronic hypertension

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