ECG Quiz…

This one fell in the bucket: “John, you had better go check this out.”

The septuagenerian presented to the emergency department because of repeated bouts of syncope. (Syncope is medical speak for temporary loss of consciousness.)  As Indiana electrophysiology fellows, we had two categories of passing out: “he passed out…cold,” or “he passed out…stone cold.”

In this case it was “stone cold.”

The presenting ECG is here:

Click to enlarge

Subsequent rhythm strips are here: (this pattern was repetitive…until an intervention was made)

Click to enlarge

What is the diagnosis?

What immediate intervention fixed the problem?

Hints:

  • Electrolyte values were normal.
  • The patient’s cardiac device was functioning normally.
  • The ‘best’ treatment worked like magic.
  • The patient was being treated for AF.
Please feel free to post your answers in the ‘comments’ section.
I’ll post the answer in a day or so.
JMM

3 comments

  1. 12 lead shows a-paced beats with long PR, LAFB, RBBB and LONG QT. Frequent PVC's and a couplet are there with appropriate pacer inhibition. Rhythm strip with Polymorphic VT, torsades. Sounds like anti-arrhythmic drug toxicity… did you increase the pacemaker rate?

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