Pacemaker-Ventricular Wenckebach

Report:

Sinus rhythm 1

Third degree AV block 3

Pacemaker rhythm 2

Möbitz 1 (Wenckebach) pacemaker-ventricular block 4

Comment:

There is an allorhythmic succession of 2:1 and 3:2 sequences. The latter show well-marked prolongation of spike-to-QRS interval between the first and the second conducted beat; the third spike is “dropped”. One would have assumed, in the context of multiple arrests, that the ventricular pacemaker electrode had been dislodged and is now in the atrium. The paced atrial P waves are not visible, but that could be attributed to single lead monitoring. The sequences are otherwise typical of AV Wenckebach.

The intact sinus P waves, however, marching undisturbed through the strip (and, therefore, through the atria), assure us that the pacemaker is not dislodged. Blocked P waves refute electrode displacement into the right atrium.

Pacemaker-ventricular blocks have been recognised since43.

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