Paced Rhythm: Primary T Wave Changes

Report:

Sequential pacemaker rhythm 1

SVEBs, with atrial-sensed pacing 2

Ventricular fusion 3

Primary T wave inversion in multiple leads 4

Comment:

The pattern is that of global T wave inversion, usually not an ischæmic event. The T wave changes in this case are presumably ischæmic, since the patient was admitted with anginal chest pains; the enzymes remained normal and she was discharged home. An ECG taken two days earlier showed similar changes in AF (Fig 57a).

The atrial premature beats inhibit the atrial lead and have P’ waves somewhat more removed from the ensuing QRS than the paced atrial waves. Thus ventricular fusion became possible. If the pacing AV interval were longer, the patient would have slimmer, possibly normal, QRS complexes.

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