Complete Heart Block in Atrial Flutter
Report:
Atrial flutter 240/min
Third degree AV block
Junctional escape rhythm 36/min
LVH with ST/T changes ? incomplete LBBB
Comment:
One would think the patient would have been paced by now. Perhaps there were sound clinical reasons for delaying the decision.
The baseline is now occupied by regular F waves; these show no constant relationship to the QRS complexes, themselves slow and regular.
The patient changed his atrial rhythms almost daily, but remained in complete AV block. Below is sinus rhythm trace from the day before. Anticoagulation is an issue in this setting.
Fig 82a.
Fig 83. 70 year old woman on digoxin, flecainide and diltiezam for past episodes of atrial fibrillation associated with hypertensive/ischæmic heart disease. Episodes of bradycardia were noted by her local doctor; later in the CCU similar rates caused symptomatic hypotension. List four electrocardiographic abnormalities present.
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