This patient has an underlying atrial fibrillation with complete heart block and an idioventricular escape rhythm. She was treated successfully with a permanent implanted pacemaker.
Idioventricular escape rhythm
This ECG is from an 84-year-old man who experienced dizziness and a fall. He was not injured in the fall. In this ECG, we can clearly see regular P waves at about 110 per minute. We also see wide QRS complexes at about 52 per minute. There is AV dissociation - there are no regular PR intervals, or even progressively-prolonging PR intervals. The atrial and the ventricles are beating to separate rhythms. What is interesting about this rhythm is the origin of the escape rhythm.
This six-second monitor strip was from a patient who was designated "Do Not Resuscitate", and whose heart rhythm was slowing dramatically. It shows an idioventricular escape rhythm, with very wide QRS complexes and only two complexes in six seconds. (The top arrows mark three-second segments.) If you look closely at the points marked by the lower arrows, you will see small, uniform, regular P waves. The mechanism leading to this agonal rhythm was complete heart block. A longer strip would show the P waves as all alike, and fairly regular, but slowing.
This rhythm strip represents an idioventricular rhythm: the QRS complexes are wide and the rate is very slow. There are no P waves associated with the QRS complexes. In this Lead II strip, there appears to be an underlying atrial flutter. If that is the case, the patient has a complete heart block preventing any of the flutter impulses from activating the ventricles. Checking in more leads would confirm atrial flutter if present. Note that the idioventricular rhythm is subtly slowing. This patient was pulseless and not breathing.
This is one of five consecutive serial ECGs that I performed several years ago on a patient in our Outpatient ECG Lab. The patient was asymptomatic and the ECG was ordered as "Routine" by the patient's Primary Care Provider (PCP). I deliberately "froze" the tracing on the screen and captured this image because I wanted to show a transition on the ECG.
No clinical patient data available.
What does this tracing show? Choose the correct answer from the list below.
All our content is FREE & COPYRIGHT FREE for non-commercial use
Please be courteous and leave any watermark or author attribution on content you reproduce.