Ventricular Escapes in Wenckebach Pauses
Report:
Sinus rhythm
Second degree AV block, Möbitz 1 (Wenckebach)[!xe "AV block:second degree:Möbitz 1:ventricular escape beats" \b!]
VEBs[!xe "VEBs:escape beats:accelerated, in 2o AV block" \b!]
Comment:
The VEBs increase the length of Wenckebach pauses: there are now two blocked P waves.
One of the advantages of the term VEB - as opposed to VPC or VPB - is that it encompasses both the ventricular premature beats and the ventricular escapes. A definitive discussion of VEB terminology â not necessarily applied in this Library â is provided by Marriott23. At any rate, the VEBs in this example are late â they are escape beats.
The small rS complexes could also be junctional, with non-phasic aberration, but the latter is rarely as marked. They are only 0.12â long and the initial vector is the same as in sinus beats. However, other leads (not available) may always show more striking differences. Their escape intervals are relatively short, projecting a rate of 75/min. The combination of Wenckebach 2o AV block and accelerated escape hints at digoxin toxicity.
The treatment of choice, for the time being, would seem to be no treatment: stop the digoxin.
Fig 29. 81 year old woman with ischæmic cardiomyopathy accidentally disconnected from the temporary pacemaker in CCU. List 4 electrocardiographic diagnoses.
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