ECG Quiz Prof. Dr. Johnson Francis | April 23, 2018 | ECG / Electrophysiology, ECG Library | 4 Comments ECG Quiz Findings and possible etiology? Please click here to read the discussion Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related Posts VPC couplet – ECG strip No Comments | Jul 1, 2014 Paced rhythm with retrograde P waves No Comments | May 26, 2016 Tachycardia mediated atrial cardiomyopathy and left atrial appendage velocity No Comments | Apr 23, 2012 Reel syndrome vs pacemaker twiddler syndrome No Comments | Apr 22, 2012 4 Comments Dr Syed Aijaz Nasir April 23, 2018 Intermittent Ventricular Pacing Purneshwar Kumar Pandey April 23, 2018 Pacing Christopher April 23, 2018 1. Sinus bradycardia (<50 bpm) 2. Ventricular (escape) pacing at 50 bpm 3. Variable morphology of the ventricular paced beats. That much is clear. The grouped beats with variable morphology of the paced impulses almost suggests a fusion mechanism (or rate related changes). The short-coupled appearance of the final v-paced complex and sinus complex in each group suggests an escape-capture mechanism. I have three thoughts: 1. Sino-atrial block with a ventricular pacemaker leading to escape-capture trigeminy (bigeminy? is it only the last two that participate?). 2. Sinus bradycardia, ventricular (escape) pacing, (hidden) retrograde conduction to the atria, setting up escape-capture bigeminy at the end of the group. 3. Sinus bradycardia, fusion of a junctional escape and ventricular (escape) pacing, setting up escape-capture bigeminy at the end of the group. This is a great strip. Christopher April 23, 2018 Or a simpler answer on further thought: – Pacemaker trigeminy due to the particular combination of the sinus rate (~40ish?) and the ventricular escape interval (1200 ms/50 bpm), with the paced QRS complexes exhibiting the concertina effect Add a Comment Cancel replyYou must be logged in to post a comment.