The Race Is Not to the Swift…
Report:
Sinus rhythm & arrhythmia 58 - 74/min.
Left anterior hemiblock (LAHB).
Right bundle branch block (RBBB).
Second degree AV block, 2:1, rate-dependent.
Comment:
The patient has, in addition to obvious conduction problems, an abnormally marked sinus arrhythmia: impulse formation may not be much better than their conduction.
At the time of transition to 1:1 conduction, the sinus slowing is almost imperceptible, but it becomes quite marked further down the rhythm strip. The resolution of the block with slowing of the sinus rate indicates its rate-dependency; it would have been interesting (but unethical) to see its response to atropine. A block at the ventricular level would be expected to get worse. Festina lente!
Most centres would advise prophylactic pacing for this ECG. I would prefer to offer it at the slightest provocation.
If you have any suggestions for or feedback on this report, please let us know.
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