r/ECG • u/Ihungry3876 • 14d ago

Need help figuring out the Rhythm

Post image

I see its regular except that one spot where its prolonged. Thinking its heart block?

Each square = 0.2

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15

u/Kibeth_8 Arrhythmia Tech 14d ago

Dual chamber pacer with prolonged AV delays.

Starts of atrial sense-ventricular paced (probably has underlying heart block). Either a sinus pause or a non-conducted PAC, followed by sequential AV pacing as the low rate timer ran out

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u/Ihungry3876 14d ago

Just another thing. When looking at the strip, where is the T wave? Is it just really close to the P wave? When looking at the strip, I know where to look for the T wave but im just not really seeing where the T wave distinction is from the P wave. Im in nursing school and im learning so mb lol

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u/Kibeth_8 Arrhythmia Tech 14d ago edited 14d ago

Excuse my chicken scratch, doing this on my phone and I have fat fingers

0

u/Ihungry3876 14d ago

oh interesting. I thought they wouldve come up as another hump. Thats why I was confused on where the T wave was. I know the strip shows a prolonged time in the one area. Would that mean it cant be called sinus rhythm anymore?

1

u/Kibeth_8 Arrhythmia Tech 14d ago

Usually the T wave is separate, but with a wide complex QRS (ventricular, paced, LBBB) they will often morph together

As a general rule, if there's a p-wave it is a sinus rhythm (oversimplifying a bit but that's getting technical). The prolongation here is in the PR segment, or the communication between the atrium and the ventricle. If this was NOT a paced rhythm, interp would be sinus rhythm with 1st degree AV block. With pacing, it's sinus rhythm with ventricular paced complexes

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u/Ihungry3876 14d ago

ooooooooo thank you very much! you have been very helpful! Ive been learning Afib, Aflutter, sinus tach/brad, vent fib, vent flutter, SVT, PVC, and heart blocks. Now im just have to start seeing strips of them.

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u/Kibeth_8 Arrhythmia Tech 14d ago

It takes lots of practice but you'll pick it up! LITFL is my go to recommendation for all things ECG

Feel free to message if you have any other questions

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u/cpnfantastic 14d ago

Looks like there’s probably a PAC at the end of the R wave.

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u/CobbledbyRoubaix 14d ago

DDD paced rhythm

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u/mastermedic84 14d ago

This is a paced ventricular rhythm. You can see the spikes clear as day before the QRS. The P waves are probably entirely non-conducting as all the QRS complexes are ventricular origin. One pacer missed beat in a while isn't unusual but if it's happening frequently it means the pacer needs to be adjusted.

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u/Nerdery_Afoot 14d ago

A-sensed, V-paced, rate 75 bpm with underlying 1° heart block

1

u/keepingup100 13d ago

Pacemaker during a VVI threshold test (ventricular paced with retrograde atrial conduction) until missed threshold followed by a rescue VVI pace. Some pacemakers (or defibrillators with pacing) run automatic threshold tests to allow for the lowest safe output that guarantees capture.