A/Prof Harry Mond

[A/Prof Harry Mond @prof_mond]

Interpolated atrial trigeminy with aberration

anyone disagree? 😉

[A/Prof Harry Mond @prof_mond]

Next one, answer in 5 words; no more, no less!

[A/Prof Harry Mond @prof_mond]

How about this one? Lots to unpick...

[A/Prof Harry Mond @prof_mond]

@narrowQRS @MelbourneEPdoc @SergioPinski Apologies also, I think you are correct that, in my preoccupation with working out which lead was losing capture, I labelled the complexes the wrong way around on the original answer

[A/Prof Harry Mond @prof_mond]

How about this one?

[A/Prof Harry Mond @prof_mond]

@narrowQRS @MelbourneEPdoc @SergioPinski unipolar RV pacing with post mortem. The R wave in V1 is not artefact from the tall stimulus artefact.

[A/Prof Harry Mond @prof_mond]

Another example similar to alternate Wenckebach sequences.
There are 2 foci for generating Wenckebach sequences, but only 1 area of AV block.
There are overnight Wenckebach sequences from a sinus focus as well as Wenckebach sequences in atrial bigeminy.
Very innocent!
Harry Mond

[A/Prof Harry Mond @prof_mond]

The left ventricular stimulus artefact (LVp) is ~ 60ms prior to the right ventricular stimulus artefact (RVp). V1 shows initial left ventricular pacing.
The second complex shows biventricular capture (RVcapture) and the next complex right ventricular exit block (RVexit block)

[A/Prof Harry Mond @prof_mond]

The 12-lead ECG clearly shows atrial pacing in many leads and two ventricular stimulus artefacts. I chose V1 and V6 to highlight the paced QRS complexes. Doesn’t really show atrial pacing (Ap).

[A/Prof Harry Mond @prof_mond]

The two consecutive blocked beats occurs when the cycles align to allow a beat to be blocked distally and then the next beat to block proximally. After this both segments reset and the cycle starts over again 3/3

[A/Prof Harry Mond @prof_mond]

What’s the mechanism here? Answer in a few days!

[A/Prof Harry Mond @prof_mond]

This is due to alternate or multilevel Wenckebach. Wenckebach is occurring both proximally (at least 5:4 conduction) and distally (2:1). The distal block explains the alternating blocked beats. 2/n

[A/Prof Harry Mond @prof_mond]

Lots got it right -Well done! Alternate Wenckebach (or multilevel AV block). More details here https://t.co/atbqOKWLSZ p1257)