Complete heart block and intermittent pacing

Complete heart block and intermittent pacing

ECG showing complete heart block with wide QRS escape rhythm and a few paced complexes with pacing artefact immediately preceding the QRS are seen – 2nd and 4th QRS complexes in the rhythm strip. Independant P waves are also seen. In this case the intermittent pacing is due to battery failure of the pulse generator and a replacement is needed. The paced QRS complexes have left bundle branch block morphology with left axis deviation, indicating pacing from right ventricular apex. The spontaneous rhythm also has a left bundle branch block morphology.