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- Initial ventricular rate ~50 bpm
- Mean atrial rate ~54 bpm
- Initial regular sinus rhythm rate ~50 bpm
- Then slowing of atrial rate (5th complex) to ~40 bpm
- Followed by ~3.8s of ventricular standstill
- Single ventricular complex
- Followed by further pause of >9 seconds
- Persisting P waves throughout
- PR - Prolonged (~240ms)
- QRS - Normal (100ms)
- Irregular baseline lead II
- Intermittent ventricular standstill
What happened ?
The patient recovered spontaneously from this recorded event and was admitted for PPM insertion. No identifiable or reversible cause was found.
Cause of ventricular standstill include:
- Myocardial ischaemia or infarction
- Atrioventricular nodal disease including degenerative and infiltrative
- Medications including amiodarone, beta blockers, calcium channel blockers and digoxin
- Electrolyte imbalance
- States of increased vagal tone
References / Further Reading
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.