This ECG is taken from an elderly man who has a history of complete heart block and AV sequential pacemaker. On the day of this ECG, he presented to the Emergency Department with chest pain and shortness of breath. His vital signs were stable and within normal limits. We do not have information about his treatment or outcome.
When using a transcutaneous pacemaker, it is important to remember that the pacing stimulus can cause an artifact on the ECG. This artifact is sometimes confused for a QRS complex. Also, the pacing of the chest wall muscles can be misinterpreted as
This ECG is taken from a woman who had suffered for several years with intractable intermittent atrial fibrillation. She had tolerated medications poorly, and several attempts at electric cardioversion had resulted in only temporary relief.
This is a good example of an AV Sequential pacemaker in a patient with an intact AV conduction system. The pacemaker is pacing the right atrium, and the impulse is being transmitted normally down through the AV node and the interventricular conduction system.
This ECG was donated to the ECG Guru by Brent Dubois, and was originally published on the FaceBook page, Paramedic Tips & Tricks. We published it to this site three years ago, but believe it should be shown again, as it is somewhat rare to catch a good-quality 12-Lead ECG of an implanted cardioverter-defibrillator pacemaer using overdrive pacing to terminate a ventricular tachycardia. Most of our examples have been rhythm strips.
No instructor's collection should be without an atrial paced rhythm OR a right bundle branch block. Here, you get both. First, the atrial pacing. This patient had a sinus node problem, but his AV conduction system was functional (if not perfect). At this time, he is able to conduct impulses from the atria to the ventricles. What he cannot do is reliably produce the impulse in his atria. So, this pacemaker is currently pacing the right atrium, producing a paced "P" wave, which is then conducted to the ventricles.
This ECG is taken from a patient with an implanted pacemaker who was experiencing near-syncope. She was taken to the hospital by EMS, where the pacemaker was adjusted to obtain ventricular capture. This ECG did not have a Lead II rhythm strip, so the 12-lead ECG is being presented. The P waves have been marked with a "P", pacemaker spikes marked with an arrow, and the QRS complexes marked with a "J" because they are junctional.
This is a rhythm strip from a NIPS procedure (non-invasive programmed stimulaltion), which is a programming test for an implantable cardioverter defibrillator (ICD). The test is done under light anesthesia, similar to that used for colonoscopy. In this example, the patient is in normal sinus rhythm at the beginning of the procedure. The pacemaker technician overdrives the patient's rate to observe the pacing function, then a stimulus is delivered to cause ventricular fibrillation (V Fib).
Patient's clinical data:
75-year-old white man who presented to the emergency department. The patient was ventricularly paced on an emergent basis and the indication was probable complete AV block with an ineffective junctional escape rhythm. I don't believe this patient survived the admission of this hospital visit.
This is an interesting ECG for showing students AV sequential pacing and also ventricular tachycardia. The unusual thing about this ECG is that the V Tach starts at the time the machine begins recording the precordial leads. This particular ECG machine shows a slight "gap" at the lead change, so we don't see the actual start of the V Tach. Both rhythms have wide QRS complexes.
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