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We admitted him for probable EP study and possible pacemaker. He underwent pacemaker placement and is doing fine. SSS is by far the most common reason for permanent pacemaker placement. during which sinus bradycardia and arrhythmia are seen but not to a degree that produces symptoms. Learning Points: 1.
Resuscitation was initiated and this ECG was obtained: Likely AFib (irregularly irregular) with bradycardia. She was intubated and a transvenous pacemaker was inserted with good capture. In addition to marked bradycardia — could there be high-grade AV block? Atropine produced no response. She received PR aspirin.
Interpreting the waves and detecting abnormalities: Typically, the heart conducts electricity in a pathway starting in the sinoatrial node (SA), our heart’s “natural pacemaker”, located in the wall of the right atrium. Sinus bradycardia – sinus rhythm below 60 bpm is a sinus bradycardia.
There are 3 etiologies I always think of with bradycardia and AV block: 1. She had a permanent pacemaker implanted. After pacer AND conversion to sinus rhythm: Computer diagnosis: IMPRESSION ELECTRONIC VENTRICULAR PACEMAKER ABNORMAL RHYTHM ECG What is missing from this interpretation? Hyperkalemia. Her K was normal 3.
. = My Comment by K EN G RAUER, MD ( 3/15 /2023 ): = I found today’s case highly instructive in highlighting a number of important aspects regarding the presentation and initial treatment of a patient who presents to the ED with new AFib. I focus my comment on a few additional aspects regarding new AFib.
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