Left Ventricular Pacemaker
Report:
Atrial flutter 320/min 2
Probable third degree AV block 3
Ventricular pacemaker rhythm 80/min 2
Left ventricular lead 3
Comment:
By coincidence, the F wave rate is almost exactly four times the paced QRS rate and the impression is strong of flutter with 4:1 block. There is, however, no fixed F-QRS relationship: the two rhythms are completely dissociated. In this context, the diagnosis of 3o AV block is only presumptive – conduction of flutter with ventricular response slower than 80/min is still, in general, quite possible. In this particular case, it isn’t: the patient had a His bundle ablation!
The frontal plane pacemaker axis is a Northwest one and the V1 morphology is consistent, inter alia, with a left ventricular pacemaker. The patient had an epicardial lead implanted following His bundle ablation.
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