Remove Atrial Flutter Remove Ischemia Remove Pacemaker
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A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The ECG was interpreted as showing atrial flutter with 2:1 conduction. Are you confident there is no ischemia?

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A man in his 70s with acute chest pain and paced rhythm.

Dr. Smith's ECG Blog

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. LAFB, atrial flutter, anterolateral STEMI(+) OMI. EKG shown here: LAFB with no clear signs of OMI or ischemia.

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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

Evidence of acute ischemia (may be subtle) vii. Negative predictors of adverse outcome: Pacemaker Pre-syncope or "near-syncope," but there is still some small risk (5, 18) These last two are identified in studies, but I consider them dangerous signs and symptoms in their own right, as above: 10. Left BBB vi. Pathologic Q-waves viii.

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Chest pain and rapid pacing followed by an unexplained wide complex tachycardia. Time for cardioversion?

Dr. Smith's ECG Blog

No evidence for ischemia jumps out. How does a pacemaker accomplish RBBB morphology? Quick aside on device terminology (feel free to skip): A "single chamber" pacemaker is a device with only one lead. A "dual chamber" pacemaker is a device with an atrial lead and a ventricular lead. ECG 1 What do you think?