This ECG was given to a Cardiologist to report and immediately returned with the comment. “Can’t report it as the ECG is too busy!”. I am sure we all want to say this sometimes.
How do we try and work out what is going on?
Divide it into its separate components.
There is also group beating. When the QRS complexes are all the same in group beating, think of Wenckebach AV block.
The features are consistent with high degree AV block.
There is another feature which is almost always overlooked.
The P-P interval with the embedded QRS is shorter (740-780 ms) than the P-P interval without a QRS (820-840 ms). This is a well known physiologic phenomenon called ventriculophasic sinus arrhythmia.
Features of ventriculophasic sinus arrhythmia
So you want more examples?
Wenckebach AV block
2:1 AV block
Complete heart block
Complete heart block with long pauses
Physiology and timing.
Harry Mond .
In 49+ years as a practicing cardiologist, Dr Harry Mond has published 260+ published manuscripts & books. A co-founder of CardioScan, he remains Medical Director and oversees 500K+ heart studies each year.
Download his full profile here.