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This post is an answer to the Case – ECG Case 337

• Rate:
  • Initial ventricular rate ~150-160 bpm
  • Period of ventricular bradycardia
  • Subsequent increase in ventricular rate
  • Atrial rate variable ~100-110 bpm

• Rhythm:
  • Initial 7 complexes
    • Mix of sinus and accelerated junctional rhythm
  • Next 2 ventricular complexes
    • 2:1 AV block
  • Period of complete AV block / high grade AV block
  • Next 2 ventricular complexes
    • Sinus rhythm
  • Followed by accelerated junctional rhythm
• Axis:
  • Right axis deviation
• Intervals:
  • PR – Normal
    • During periods of sinus conduction
  • QRS – Normal
• Additional:
  • Dominant R waves in leads V1-2
  • Meets voltage criteria for biventricular hypertrophy
  • No features of strain or Q waves

Interpretation

Tachy-brady syndrome

• Accelerated junctional tachycardia
• High grade AV block
• Patient was symptomatic during these episodes of bradycardia complaining of dizziness and nausea. During episodes of tachycardia he experienced palpitations.

What happened next ?

He had no reversible cause including culprit medications and normal biochemical assessment. He was transferred for tertiary management and following further investigation including EP study underwent a PPM insertion.

READ ALSO:

• ECG Interpretation: All you need to know
• Conduction Blocks at the AV Node (AV Blocks) [With Examples]