VEBs: Long Compensatory Pauses
Report:
Sinus rhythm 97/min
VEBs
Right bundle branch block
Probable old inferior infarction
Comment:
The pauses containing the VEBs are obviously longer than two sinus cycles. This admits only one explanation – the VEBs have been conducted retrogradely to the atria, not only resetting the SA node, but depressing it as well. The retrograde P waves remain invisible but are there by inference. The proof is in the length of the first subsequent sinus cycle: it is longer than its successor. The post-ectopic SA depression (overdrive suppression) has taken place here.
These VEBs are also a good example of the left rabbit ear sign denoting their ventricular ectopic origin.
The computer reported this patient’s axis as +154o and called his conduction “bifascicular block: RBBB & LPFB”. This is not so: the axis of the initial 0.06” in the frontal plane is normal. The late contribution of the RBBB must be discounted in calculating the frontal plane QRS axis.
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