Atrial Fibrillation with Complete AV Block
Report:
Atrial fibrillation
Third degree AV block
VEB
Junctional escape rhythm 42/min
Possible old inferior MI
Diffuse ST/T changes
Comment:
The ventricular rate is completely regular and slow, disturbed only by a single VEB. The VEB looks like LBBB, but isn’t: its slow descent and sharper upstroke in V1 are quite reliable distinguishing features. There is an incompletely compensatory pause, as expected, since the VEB depolarises the junctional pacemaker and resets it.
The proximate cause of the block may well be the ß-blocker, but its substrate, the AV node, was probably more than touched by previous inferior infarction.
This is your opportunity to make a rare electrocardiographic diagnosis.
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