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

Textbook

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

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