Chronotropic Incompetence
Report:
Atrial fibrillation with “controlled” response
Accelerated idioventricular rhythm (AIVR)
VEBs
Comment:
Although the ventricular rate appears favourable, it is in fact inappropriately slow in the setting of shock, pulmonary hypertension (see the pressure readout) and catecholamine therapy. Even in AF, the relatively slow ventricular rate implies that the end may be nigh. Ventricular pacing (the only possible mode here) does not appear to be helpful. Septic shock can cause profound myocardial and vascular depression; chronotropic incompetence208 is a marker, as well as a contributor, of a bad outcome.
If the only reason for this patient’s chronotropic incompetence was isolated AV nodal block, the outlook would be brighter and a trial of pacing would be justified. This is of course not discernible from the rhythm strips alone.
The VEBs are escape beats in this setting; they are obviously part of the AIVR manifest at the end of the top strip and the beginning of the bottom strip.
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