Junctional escape rhythm
This ECG was taken from a 90-year-old woman. We have no other history, unfortunately. It is a good example of a sinus rhythm with complete AV block, also called third-degree AV block.
The defining characteristics of this rhythm include: 1) an underlying rhythm that is regular and with a physiological rate. In other words, the P waves are not so fast that they would not be expected to conduct one-to-one. 2) a second rhythm of regular QRS complexes that is unrelated to the P waves.
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.
At this time of posting, I currently have no clinical data for this patient. This ECG is of interest because of its arrhythmic and nonarrhythmic elements.
I can think of at least two possible explanations for the mechanism of this rhythm and both would benefit from being illustrated by a laddergram.
One mechanism is rather exotic and has not been previously seen here on this website or discussed in the various FB forums.
This patient was seen by his primary care provider (PCP) on an outpatient basis. The PCP decided to send her patient over to me to perform a routine ECG and establish a baseline, hince the computer's statement below of "No previous ECGs available". I printed out the above 12-lead ECG and became slightly concerned with the rhythm I was seeing. Consequently, I also recorded six full pages of continuous rhythm (not shown here). I don’t ordinarily resort to doing this
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