VEB and DDD Pacemaker
Report:
Sinus rhythm 73/min 1
VEB 3
Atrial-sensing ventricular pacemaker 4
Atrial-paced beat 2
Comment:
Universal (DDD) pacemakers can both sense and pace the atria. The pause created by the VEB is terminated by an atrial-paced P wave and ventricular-paced QRS. The paced atrial wave looks similar to sinus ones in the L2 rhythm strip, but is obviously different in V6 above.
The post-ectopic emergence of atrial pacing is identical to that in Case 8. Repetitio mater studiorum.
The paced beats have a negative concordant precordial pattern and slurred downstroke in the right precordial leads characteristic of right ventricular ectopy. This is of no diagnostic value here (all such beats being obviously paced by a transvenous RV lead), but it is a pattern worth remembering in diagnosis of VT.
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