Pseudo P Waves

Report:

Ventricular tachycardia 102/min

Sinus rhythm 70/min

Sinus capture (fusion) beats with first degree AV block

Comment:

The initial QRS forces mimic a P wave70 and would be difficult to differentiate from it were it not for the presence of large, biphasic, sharply notched real P waves throughout the trace. The sinus P waves are mostly dissociated, but some effect partial captures from 0.26" away.

Fusion beats can be regarded as incomplete capture or incomplete dissociation, depending on one's view of zebra's basic colour. At any rate, here they prove ventricular provenance of the broad complexes. They occur at the time when both pacemakers (sinus and the ventricular ectopic one) are expected to capture the ventricle and they are narrower than the “pure” VT beats.

76. 73 year old lady with toxic digoxin level and recent CVA due to endocarditis. She has been transferred to CCU for cardioversion under general anæsthesia. Will she wake up?

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