Question:
87 yo M who is 2 days S/P TAVR; What is the complete interpretation of this EKG?
Answer
- Sinus rhythm at 94/min
- Accelerated junctional rhythm at 72/min
- AV dissociation
- AV block, 3⁰
- Left axis deviation (>-30⁰)
- Left ventricular hypertrophy with secondary repolarization abnormality
Learning points:
Atrioventricular dissociation is a nonspecific term that merely indicates that the atrial and ventricular rates are different. Complete AV block (AV block 3⁰) exists when the atrial rate is faster than the ventricular, the rates are constant, and there is no relationship between atrial and ventricular events. In this EKG both AV dissociation and AV block 3⁰ pertain. However, the escape mechanism is from the AV junction at a rate of 72/min and the cardiac output is preserved better than if the escape mechanism were ventricular at a rate in the 40’s. The decision regarding the need for a permanent pacemaker could be delayed.
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