Idioventricular Rhythm in Complete AV Block
Report:
Sinus arrhythmia & bradycardia
Junctional rhythm 48/min, also blocked
Third degree AV block
Idioventricular escape rhythm 10 â 30/min
Comment:
The (blocked) sinus rhythm is slow and irregular. Eventually it is replaced by somewhat more constant junctional rhythm, with retrograde (down-up, rather than up-down) P waves (also blocked). There is a problem with impulse generation as well as conduction.
The idioventricular escapes stop for almost 10 seconds in the second strip, only to resume at 10 â 12 beats per minute; the patient had to be paced in a hurry. The morphology of the escape beats resembles RBBB, perhaps indicating an escape focus in the left bundle branch territory. The 12-lead ECG on admission is shown below (Fig 128a).
Fig 128a. Evidence of anterior and inferior infarction in junctional escape rhythm. Fig 129. 47 year old man with extensive anterior infarction and cardiogenic shock. Exact doubling and halving the heart rate is always interesting.
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