Answer to ECG of the Week 04 November 2013

                 Answer  
         ECG of the Week 

04 November 2013

This ECG was a little tricky.

I’ll let this week’s winner provide the answer;

“It’s underlying complete heart block with Ventricular pacing turned down to a rate of 30-35?”

            Complete heart block is easily identified by the complete disassociation of P waves to Ventricular QRS's.

            The absence of ventricular pacing spikes make the second part of the interpretation is a little more difficult.

            The Morphology of the QRS is all that you had to go on (where the ventricles are being stimulated from or where the ventricular impulse begins).

           

First look at the Ventricular Rhythm, its regular.  Next look at lead V₁. The QRS is negative and very wide (>120mS), so that makes it a Left Bundle Branch Block (LBBB). A LBBB indicates that the impulse is originating somewhere in the right ventricle.

            Look at all of the V leads. In the V leads there is not a transition from Negative to Positive. Meaning The V leads are “pointing” at the right ventricular apex. 

Question, when a pacemaker is implanted, where is the RV lead placed? Answer; The right ventricular apex.

This patient was 100% pacer-dependent. They were in the procedure room for an A-fib ablation. The patients pacemaker had be programmed to VVI 40 just prior to the start of the procedure. The ECG was a result of the device programming.

Congratulations to Beth…..again!!!!  She was the first to submit the correct answer.

Honorable mention this week goes to: Theresa, Maribeth, Jamie and Diana.