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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