Ventricular Standstill in Sinus Tachycardia
Report:
Sinus tachycardia 113/min
Second degree, mostly 2:1 AV block
Complete AV block – ventricular standstill
Intraventricular conduction delay (known LBBB)
Comment:
This is almost certainly Möbitz 2 AV block in view of the associated bundle branch block and sudden asystole. We do not see the transition from 1:1 to 2:1 conduction and the diagnosis of Möbitz 2 remains only presumptive.
Below is a strip obtained about 20 minutes later (Fig 46a), as the 2:1 conduction returned. By then the sinus rate accelerated to over 140/min. The CPR was not going well but the patient survived, at least temporarily.
Fig 46b is another strip taken during the CPR (or the lack of it). The appearance of rather slow ventricular escape rhythm (with dubious output) caused the treating team to stop the chest compressions and gaze at the monitor. The massage artefact reappears at the end of the second strip.
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