VEBs: Retrograde Conduction
Report:
Sinus rhythm
VEBs, trigeminal, uniform
Retrograde VA conduction
Left atrial abnormality (LAA)
Borderline right atrial abnormality (RAA)
Probable old posterior infarction
Nonspecific ST/T changes
Comment:
The compensatory pauses are longer than two sinus cycles, despite the obvious retrograde conduction, which should render the pauses incompletely compensatory (like with SVEBs). This is due to post-ectopic sino-atrial depression (overdrive suppression), delaying the SA discharge. Any prematurely depolarised pacemaker may show this phenomenon. It is one of the factors making the compensatory pause such a poor discriminator between VEBs and SVEBs.
The posterior MI is evident from the broad primary R wave in V1 (>0.04â), even if the R/S ratio remains below 1.0. The T wave is upright.
The P wave axis of +70o is probably significant in this patient with COAD; it is an early sign of pulmonary emphysema136.
Below (Fig 189a) the single VEB has no retrograde conduction. 189a. The VEBâs retrograde conduction is blocked â the visible sinus P wave â also blocked â has beaten it to it. There is a compensatory pause. 190. Outpatient ECG in an 82 year old man with history of cardiac irregularity.
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