Complete Heart Block in Atrial Flutter

Report:

Atrial flutter 240/min

Third degree AV block

Junctional escape rhythm 36/min

LVH with ST/T changes ? incomplete LBBB

Comment:

One would think the patient would have been paced by now. Perhaps there were sound clinical reasons for delaying the decision.

The baseline is now occupied by regular F waves; these show no constant relationship to the QRS complexes, themselves slow and regular.

The patient changed his atrial rhythms almost daily, but remained in complete AV block. Below is sinus rhythm trace from the day before. Anticoagulation is an issue in this setting.

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