Top Tracings
You Should Know before the Exam
device tracings • ecgs • egms
swipe for more -->
T wave oversensing causing suboptimal BiV pacing
Inappropriate shock from R wave double counting
Far field R wave oversensing w/ V bigeminy
1.2
Noise in Device Tracings
Defibrillation SVC-RV Shock Coil Reversal
DDx: Conductor Fx, Loose set screws, or Insulation breach.
1.3
Managed Ventricular Pacing
AAI-DDD mode switch. Noted with AP without VS followed by AP-VP with a very short AV delay.
Long-short sequence from MVP algorithm induced VT.
2.1
Noise in ECG Tracings
Moving artifacts with 'Notch' sign.
Moving artifacts. Always look at all leads.
Sinus rhythm with moving artifacts.
Pause artifacts. QRSs did not end with T waves.
T wave inversion across chest leads (beyond V3),
the most common finding in ARVC.
VT from RV base or septum (not RVOT).
2.3
Intermittent Pre-excitation
Consider ablation only if symptomatic or in a high-risk occupation.
2.4
2:1 AV Block with P waves hidden in T waves
Noted with strange-looking T waves in aVF.
Noted with strange-looking T waves in V1-V3.
Exercise testing helps to evaluate the level of block. As shown, the block is worsen with faster sinus rate consistent with infra-Hisian block.
Sinus rhythm with 2:1; Infra-Hisian Block. A-H without V.
Mobitz I or Wenchkebach. A-H-V, A--H-V, A---H-V, A without HV.
VT: VA dissociation is demonstrated.
Narrow complex tachycardia, V:A = 1:1, first A in distal CS. DDx: OAVRT using L sided P/W vs. Left-sided AT.
4.1
Ventricular Premature Beat (VPB) that terminated SVT.
His synchronous VPB without retrograde atrial depolarization terminated SVT. AVRT is most likely.
Similar tracing to the previous. AT & AVNRT can be excluded.
VPB was not His synchrounous. SVT was terminated without A.
AT was excluded. AVNRT & AVRT remained possible.
VPB was not His synchrounous. SVT was terminated with A.
AT, AVNRT, & AVRT remained possible.
4.2
Entrained or Not Entrained
Not Entrained. V rate was unchanged.
Not Entrained. A rate was unchanged.
SVT was terminated and reinitiated -- NOT entrained.
Entrained with psuedo V-A-A-V response.
4.3
During RF Ablation of Slow Pathway
Junctional rhythm with no retrograde A. Ablation needed to be terminated.
Prolonged VA conduction followed by AV block after RF terminated.
JR occurred during catheter ablation of inferior septal PW. Delta wave disappears gradually because of
accelerated JR from AV node heating. RF should stop.