Agonal Rhythm & Paper-End Mark

Report:

Junctional or accelerated idioventricular rhythm (AIVR) 52/min.

1:1 retrograde conduction.

Comment:

The sinus rhythm is completely regular in brain death and usually faster than while vagal tone was still extant, except in profound hypothermia. This is less obvious in rhythms, like this one, originating from a subsidiary pacemaker.

The presence of the ECG stripe implies that the current tape is about to run out. For some (undoubtedly psychological) reasons, this is most often seen in agonal patients’ records: the end is nigh. Several possible mechanisms may be at work here: reluctance to change the paper in view of the impending end, frequent sampling of often bizarre rhythms, the frequently slow rhythms agonally requiring longer segments of the tape, etc. I always thought that it would make an interesting study for publication-hungry junior staff.

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