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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