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- Ventricular rate ~54 bpm
- Atrial rate ~96 bpm
- Complete AV dissociation
- Variable rate ventricular rhythm
- Variable rate atrial rhythm
- Left axis deviation
- QRS - Prolonged
- RSr' pattern V2
- Slurred up-stroke QRS in leads I, aVL, V3-6
- Looks similar to a delta wave but rhythm origin is not sinus
- ? Affect of ablation or AP pathway involvement in escape rhythm
- Discordant ST depression in lateral and high lateral leads
- T wave inversion in high lateral leads
- Variable R-R interval showing ventriculophasic arrythmia
- Post ablation complete heart block
The patient was well aware of his longstanding heart block and had declined a pacemaker insertion.
Post catheter ablation complications
The are a number of potential complications of RF catheter ablation including:
- Local bleeding / infection at insertion site
- Procedural failure
- Valvular injury
- Cardiac puncture +/- tamponade
- Pulmonary vein stenosis
- High grade AV block
- Additional arrhythmic focus
- VTE & CVA
Ventriculophasic Sinus Arrhythmia
Ventriculophasic arrhythmia can be seen in up 40% of case of complete AV block.
You get a shorter P-P interval when there is an associate QRS complex with a longer P-P when there is no QRS between the P waves. Several mechanisms have been proposed including alterations in sinus node perfusion related to ventricular contraction and the mechanical effects of atrial stretch.
To make things more confusing there is a much rarer paradoxical phenomenon when the P-P is longer when a QRS is contained between them.
It is important to recognized as the P-P variability may be mistaken for other ECG features such as U waves for example.
You can read more about ventriculophasic sinus arrhythmia in this nice case report of the paradoxical version here:
- Liu T, Shehata M, Wang X. Paradoxical ventriculophasic sinus arrhythmia during 2:1 atrioventricular block. Journal of Cardiology Cases , Volume 3 , Issue 1 , e37 - e39
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.