Slow Junctional Escape in Complete AV Block
Report:
Sinus rhythm 90/min
Third degree AV block
Junctional escape rhythm 19/min
Anterior infarction ? incomplete LBBB
QT/T wave changes consistent with ischæmia or preceding syncope.
Comment:
As in the previous case, the escape pacemaker, although a friend in need30, is somewhat unreliable. The QRS looks the same as in conducted sinus beats (Fig 47a below, with 2:1 and advanced block) and the escape focus is therefore junctional.
There is no real sinus tachycardia, probably reflecting a degree of chronotropic incompetence.
The diagnosis of incomplete LBBB remains doubtful because of the uncharacteristically small voltage of the QRS complexes. The absence of septal q wave in V6 is perhaps better explained by septal infarction even though there are no anteroseptal Q waves. The non-existent R wave progression from V1 to V5 is, after all, almost equivalent to Q waves.
The T wave in V6 is suspiciously prominent, dwarfing its QRS complex. This is consistent with infarction or ischæmia.
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