40 Something Man with Palpitations and Grouped Beating: Is it Wenckebach?

FromDr.Smith:A 40 something male complained of palpitations.  See the ECG below and how Ken Grauer dissects this grouped beating.===================================MY Comment by KEN GRAUER, MD (9/27/2020):===================================The 12-lead ECG and accompanying long lead II rhythm shown in Figure-1 was obtained from a 40-something year old man who was found to have a fairly slow and irregular heart rate. He was hemodynamically stable at the time this tracing was done. Imagine this is the only history available.What is the rhythm? Is this Wenckebach?Clinically  — WHY might it matter?Figure-1: 12-lead ECG and rhythm strip from a 40-something year old man with an irregular heart rate (See text).MY Thoughts on ECG #1: This is a challenging tracing. My purpose in discussing this case is to highlight distinction between AV block vs mimics of AV block. Treatment indications for being able to quickly make this distinction are obvious =A pacemaker may be needed for more severe, symptomatic forms of AV block— whereas a pacemaker will usually not be needed for most AV block “mimics”.As always — I favor beginning with the cardiac rhythm (in the long lead rhythm strip) before assessing the rest of the 12-lead ECG. By the 5 Parameter Ps, Qs& 3R Approach  — I noted the following:P waves are present. However, it ...

Source: Dr. Smith's ECG Blog - September 25, 2020 Category: Cardiology Authors: ECG Interpretation Source Type: blogs