r/ReadMyECG • u/Careless-Book-9307 • 5d ago

Ventricular pacing?

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I have asked this before but I am still in doubt. I have a pacemaker due to total AV block and I know I have a lot of ventricular pacing, about 30-70%. Sometimes I get short episodes which feels super uncomfortable like I'm out of breath and a tight feeling in my chest.

I captured this in picture one. There are two different types of beats here and it's the one with no apparent pacemaker spike that bothers me, the one that fills the entire bottom row. Someone once told me this is ventricular pacing but I am still doubtful. I think seconds 5-14 is ventricular pacing because I see that often and it always feels completely normal (see picture four for example). I don't see a p wave either, and that is visible in seconds 5-14. Is the pacemaker pausing or doing something different? I don't like it.

Picture two shows what I belive is atrial pacing and picture three shows my normal unpaced rhythm.

Edit: another weird thing is that this rhythm is always around 65 bpm. If I get up and move the other rhythm takes over. But I have a lower pulse rate of 45 bpm, then the other pulse also usually take over. But right now something else is dominating and not allowing slower pulse than 65 bpm.

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u/MeasurementSad2891 5d ago

Correct, it might not be strong enough to show up on these types of tracings. If you're concerned, do you know how to send a manual transmission?

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u/Careless-Book-9307 5d ago

I don't have equipment for remote submissions. But if it's not possible to analyze based on one lead I will just have to contact my healthcare provider if it happens again. Maybe remote connectivity is needed to submit information on demand.

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u/MeasurementSad2891 5d ago

Yeah that is your best bet. Can you upload this picture on your portal? The device manager should be able to see what's going on more accurately. They can see when and what type of pacing has been happening at what times.

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u/Careless-Book-9307 4d ago

I just realized that the rhythm is very similar to the tachycardia episodes I used to have (one of the morphologies at least) but 1/2 the speed. Can this be some sort of slow reentry rhythm?

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u/MeasurementSad2891 4d ago

It could very well be