Escape-Capture Bigeminy in AF

Report:

Atrial fibrillation

High-grade or complete AV block

Junctional rhythm 39/min

Pacemaker (escape) rhythm

Escape-capture bigeminy

Left anterior hemiblock (LAHB)

Right bundle branch block

Anteroseptal infarction, age uncertain

ST/T changes consistent with ischæmia

Comment:

The analogous RR intervals are identical, making it unlikely that the RBBB complexes are transmitted AF. It is true that VEBs or paced beats can ‘regularise’ the response to AF, but, in the absence of advanced or complete AV block, the intervals would show some variation.

The junctional focus is protected from the pacemaker discharge

The f waves are most visible in the anteroseptal leads.

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