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Biventricular pacing

This rhythm shows biventricular pacing with trigeminal PVCs.  The third PVC is also a multifocal triplet.  The PVCs have a pacer spike fused in them.  

Identify the following rhythm (Click on the image to enlarge it). Biventricular paced beats with an 11 beat run of ventricular tachycardia. The rate of the VT is about 150 bpm.  Complex 4 is a fusion beat and you can see that the pacemaker fired at the same time the ventricular ectopic beat occur. The 5th beat falls on the later half of the T wave so this may have triggered the run of VT.  A fusion beat concludes the run of VT and biventricular pacing resumes.  

Various Biventricular Paced Rhythms 1. Biventricular Paced 2. Biventricular Paced 3. Biventricular Paced 4. Biventricular Paced 5. Biventricular paced with a multifocal couplet 6. Biventricular paced with unifocal PVCs 7. Biventricular paced 8. Biventricular paced 9. Biventricular paced with bigeminal PVCs 10. Biventricular paced

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Asystole with AV pacer spikes The underlying rhythm is asystole.   There are atrioventricular pacer spikes present but they are not capturing.   The heart is dead but the pacemaker is still functioning and generating impulses as it was programmed to do.  Usually an internal pacemaker is disabled by placing a magnet over it. 2. Atrial flutter  The rhythm is slightly irregular with a rate of 80/min.  There are flutter waves present between the QRS complexes.   No ectopic beats are seen.   PR:  ---,  QRS:  .12 sec,  QT:  .48 sec. 3. Biventricular paced The rhythm is regular with a rate of 75/min.   P waves are present, upright, and have a corresponding QRS complex.   There are biventricular pacer spikes before each QRS complex. ...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Agonal rhythm The rhythm is irregular.  The rate is 20/min.  No atrial activity is present.   The QRS complex is wide, bizzare looking, and slow. 2. Biventricular paced The rhythm is regular with a heart rate of 94/min.   The P waves are uniform, upright, and precede the QRS complexes.   There are biventricular pacer spikes seen before each QRS complex.  No ectopic beats are noted.  PR:  .12 sec,  QRS: .12 sec,  QT:  .40 sec. 3. Atrial fibrillation with slow ventricular response The rhythm is irregular with a ventricular rate of 30/min.   The R-R interval between the 1st and 2nd complexes is 1.68 sec and the R-R interval between the 2nd and 3rd complex is 1.52 sec.  No P waves are present but there looks like some small flutter waves present in the V1 lead, t...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Bigeminy The rhythm is irregular due to the unifocal PVCs.   The rate is 90.  There are small upright P waves present.  There are PVCs occurring every 2nd beat.   PR:  .14 sec,  QRS:  .16 sec, QT:  .40 sec. 2. Biventricular paced with a multifocal couplet The rhythm is irregular due to the couplet.   The rate is 80/min.  The are flutter waves between the QRS complexes.  A multifocal couplet is present.  There are biventricular pacer spikes before the QRS complexes.  PR: ---,  QRS:  .12 sec,  QT:  .32 sec 3. Trigeminy The rhythm is irregular due to the unifocal PVCs.   The rate is 80/min.   The are small upright P waves present.  The PR interval is progressively lengthening.  Unifocal PVCs are present every 3r...

Identify the following rhythms. 1. 2. 3. 4. 5. Answers 1. Atrial fibrillation The rhythm is irregular.   The rate is 80/min.   There are no P waves before each QRS complex,  only fibrillatory waves.   No ectopy is noted.   PR:  ---   QRS:  .10 sec,  QT:  .32 sec. 2. Demand pacing The rhythm is irregular.   Underlying rhythm of atrial fibrillation with some demand biventricular paced beats.   There are two pacer spikes that preceed the QRS complex on the paced beats. 3. Junctional rhythm The rhythm is regular.   The calculated rate is 53/min.   The P waves are absent.  No ectopy is noted.   PR:  ---,   QRS:   .10 sec,   QT:  .36 sec 4. Normal sinus rhythm with 1st degree block The rhythm is regular.   The calculated rate is 75/min.   There are upright P waves before e...