Pacemaker-Sinus Escape-Capture Bigeminy

Report:

Sinus rhythm

Second degree AV block, unspecified

Intraventricular conduction delay (QRS 0.12")

Pacemaker escape beats

Escape-capture bigeminy

Comment:

The conducted sinus beats have normal PR intervals, but the P waves following them have their P-pacemaker intervals longer, with paced complexes preventing the recognition of the nature of the underlying block.

The block would be, most likely, a 2:1 AV block, unable to be assigned a Möbitz status. The IVCD is, almost certainly, RBBB, but Lead 2 is not ideal for diagnosing the nature of broad complexes. The paced QS beats, at least, look as expected in lead 2: LBBB-like with LAD. The unit is a VVI one, inserted in 1987, or else its sensed AV interval is unusually long.

Fig 43. 77 year old woman with the following Cardiologist's report: "Sinus bradycardia. Prominent U waves."

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