Ventricular Escape Beat

Report:

Sinus rhythm 70/min

SVEBs

VEB

Left atrial abnormality (LAA)

Left anterior hemiblock

Right bundle branch block

Prolonged QT interval (QTc 0.50”)

Nonspecific ST/T changes

Possible LVH (R in aVL >15mm, R1 + S3 > 27mm)

Probable anteroseptal infarction, age uncertain

Comment:

The VEB starts with a small but broad R wave in V1 (Rosenbaum’s ‘normal’ pattern) on top of the sinus P wave; it comes almost a full second after the preceding beat. This illustrates the convenience of the term VEB – ventricular ectopic beat – as opposed to VPB or PVC or VPC. VEB covers both early and escape beats! The terminology of extrasystoles (Schamroth’s favourite term) remains a complex matter32,115. Incidentally, this one was originally reported as “ventricular premature complex”.

The first beat is probably a junctional extrasystole, certainly premature. There is a slight but definite sinus arrhythmia; whether the SVEB is retrogradely conducted or dissociated from sinus P wave is uncertain. This matters little.

Presumably the primary R wave (of the RBBB) in V1 is amputated by the septal infarction; its ST segment elevation supports this diagnosis. While LAHB alone can cause small Q waves in anteroseptal leads, the one present in V1 is beyond that. The hemiblock also exaggerates standard leads’ voltages and the diagnosis of LVH is less specific in its presence. 132. 84 year old lady with history of hypertension.