Sudden Ventricular Standstill

Report:

Sinus tachycardia 100/min

Borderline first degree AV block

Left bundle branch block

Third degree AV block

Ventricular escape beats (bottom)

Comment:

This is a typical example of AV block in acute anterior infarction: RBBB or LBBB (as here) followed by sudden asystole. The bottom strip is in fact agonal rhythm, recorded two minutes into the ventricular standstill. The P waves are slow and irregular, with prominent Ta (Tp) wave.

There is no PR interval prolongation prior to block, which is Möbitz 2, almost certainly intraventricular.

Pacing – a cosmetic measure in this setting - would not have altered this patient’s outcome.

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