Agonal Pacemaker Rhythm

Report:

Pacemaker rhythm 80/min 4

Broad pacemaker complexes 0.36” suggest hyperkalæmia or agonal rhythm 6

Comment:

It was the latter – agonal rhythm. I rang the patient’s physician who told me the patient had by then been allowed to die, in cardiogenic shock from end-stage ischæmic cardiomyopathy. Hyperkalæmia was probably present as well. There is an almost perfect “sine curve” in the rhythm strip.

In V1-2, the pacing spike appears well removed from the onset of the QRS, due to a large isoelectric segment.

A trace taken a fortnight previously is shown below (Fig 35a).

See also Case 67.

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