ECG of the Week - 27th August 2018 - Interpretation

The following ECG is from a 86 yr old male who presented to the Emergency Department complaining of nausea.

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Rate:

• 51 bpm

Rhythm:

• Regular
• V-paced rhythm
• Underlying atrial fibrillation

Axis:

• Extreme axis deviation

Intervals:

• QRS - Prolonged (160-180ms)

Additional:

• LBBB Morphology
• Sgarbossa negative
• Noted abnormal QRS vector in leads I, aVR and aVL
• Due to RA / LA lead reversal
• Resultant aVR / aVL switch
• Resultant lead I complete inversion
• Resultant II / III switch

Interpretation:

• V-paced rhythm resultant LBBB
• Underlying atrial fibrillation
• Lead reversal RA/LA

References / Further Reading

Life in the Fast Lane

• Paced rhythm
• Left bundle branch block
• Sgarbossa Criteria
• Lead reversal

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.