Accelerated Idioventricular Rhythm in Complete AV Block
Report:
Sinus tachycardia 120/min
Accelerated idioventricular rhythm 65/min
Third degree AV block
Comment:
One can confidently diagnose complete AV block when the atrial rate is so much faster than the ventricular, without any captures, the ventricular rhythm remaining regular. The QRS morphology is a nice example of LBBB-like complexes of ectopic ventricular origin: slurred S descent in V1 and RAD.
The ECG below should be another example of ventricular ectopic focus giving rise to LBBB-like complexes: a paced rhythm. However, V1 shows upright, RBBB-like QRS. This is uncommon, usually due to posterior electrode position in a large right ventricle or posterior intraventricular vein (through the coronary sinus).
217a. Temporary bipolar (small spikes) pacemaker in ?posterior interventricular vein. There are no sinus captures. 218. 53 year old woman on verapamil 80 mg BD. She had a negative stress test on the day of this recording.
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