Holter-Monitored Sudden Death

Report:

Sinus bradycardia 32/min (12.5 mm/sec recording)

Asystole

Comment:

The patient had a routine Holter “to exclude AF” for a recent occipital CVA and was found dead in his bed. It is not always possible to ascertain whether the death was cardiac or neurogenic in origin. Half an hour earlier (below) there was a period of tachycardia and ventricular ectopic activity associated with quite impressive ST segment depression. This could have been an initial response to hypoxæmia from respiratory failure or arrest, but equally a response to ischæmic pain. After all, he had two MIs and an aortic aneurysm repair in the past.

Agonal rhythms are quite variable, as will be seen elsewhere in this volume. Even this one did not have a smooth transition of progressive sinus bradycardia into asystole: a junctional escape pacemaker appeared after shorter standstills a few minutes before the final one (Fig 83b). The QRS in this case remained narrow throughout.

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