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Search and discover over 2,500 ECG reports written by cardiologist and intensivist Dr George Nikolić OAM.
T Wave Sensing
Report:Pacemaker rhythm 60/min 1 No atrial capture 2 No apparent atrial activity 3 Paced extrasystoles at 0.48 – 0.56” coupling; bigeminy ?T wave sensing 4 Comment: One cannot be absolutely sure that there were no retrograde P waves at the time of
Ignored VEBs in Trigeminy
Report:Sinus rhythm 1 VEBs, trigeminal 3 Atrial-sensing, ventricular-pacing electronic pacemaker 7 Comment: This case is similar to No. 86, where the pacemaker leads cannot “recognise” the slowly rising ectopic R wave. Here, however, it follows the P
Pacemaker-Ventricular 4:3 Block
Report: Sinus rhythm 1 Atrial-sensing ventricular pacemaker 3 Trigeminy due to 4:3 pacemaker-ventricular block 6 Comment:The paced beats show the expected RV apical pacing morphology of LBBB with LAD. The reason for the intermittent failure to pace is
Positive Concordant Precordial Pattern
Report:Pacemaker rhythm 63/min 2 1:1 retrograde conduction 3 Positive concordant precordial pattern 5 Comment:This is a temporary, bipolar unit, inserted in CCU. The patient had a very large right ventricle or the lead is inadvertently placed in the po
Sensing but not Pacing
Report:Sinus rhythm 100/min 2 2:1 AV block 3 Left atrial abnormality (LAA) 1 Failure to pace in atrial-sensing pacemaker 3 Prolonged QT interval 0.56” 1 Comment:The unit is almost certainly a DDD one, with preserved atrial sensing but no ventricular
Runaway Pacemaker
Report: Pacemaker tachycardia 180/min 5 Runaway pacemaker 5 Comment: Most modern pacemakers would have a ventricular rate-limiting mechanism to prevent this degree of tachycardia. The trace itself does not offer any clues as to the cause: all one can se
Battery Depletion
Report: Atrial fibrillation 1 Third degree AV block 4 Pacemaker rhythm 44/min 1 Probable battery depletion 4 Comment: Most units are programmed to slow the basic rate as the battery becomes depleted; numbers vary. It is not certain, however, that batt
Voluntary Asystole
Report: Pacemaker rhythm 70/min 2 Somatic tremor 4 Pacemaker inhibition by myopotentials 4 Comment: Unipolar pacemakers are more likely to be inhibited by myopotentials than bipolar ones. Muscle inhibition is rarely seen in modern pacemakers (this on
Reversed Atrial & Ventricular Electrodes
Report: Sinus rhythm (non-conducted) 1 Pacemaker rhythm 78/min 1 Reversed A & V leads 5 Intermittent atrial captures with 1o AV block & IVCD (unspecified) 3 Comment: This was a prank by a junior colleague, in this case harmless, but interesting. The v
Temporary AV Pacemaker
Report:Upper strips: Ventricular lead off Atrial pacemaker rhythm 80/min Loss of capture with reduced output Escape sinus bradycardia Resumption of capture at treshhold output Lower strip: Atrial pacemaker rhythm 53/min Failure to pace in two cycl