Pacing Illusion
Report:
Sinus rhythm 1
First degree AV block (PR 0.28”) 2
Atrial-sensing pacemaker – no captures 5
Incomplete LBBB (LVH with ST/T changes) 2
Comment:
The illusion of pacing is, of course, supported by the patient’s native incomplete LBBB and its left axis as well as the large unipolar pacemaker spikes preceding each QRS complex.
The initial QRS complex in the previous case (111) was isoelectric in leads V2 and V3 but here it is isoelectric everywhere – it’s not the initial (or any) QRS at all. The failure to pace was missed by the Casualty staff, who compared the trace with the patient’s previous ECG (below). The latter trace looked superficially similar to the former and the patient was asymptomatic anyway.
Why, then, was he in Casualty? He was admitted through it for repair of his AV shunt.
If you have any suggestions for or feedback on this report, please let us know.
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