Idioventricular Rhythm in Complete AV Block

Report:

Sinus arrhythmia & bradycardia

Junctional rhythm 48/min, also blocked

Third degree AV block

Idioventricular escape rhythm 10 – 30/min

Comment:

The (blocked) sinus rhythm is slow and irregular. Eventually it is replaced by somewhat more constant junctional rhythm, with retrograde (down-up, rather than up-down) P waves (also blocked). There is a problem with impulse generation as well as conduction.

The idioventricular escapes stop for almost 10 seconds in the second strip, only to resume at 10 – 12 beats per minute; the patient had to be paced in a hurry. The morphology of the escape beats resembles RBBB, perhaps indicating an escape focus in the left bundle branch territory. The 12-lead ECG on admission is shown below (Fig 128a).

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