ECG Quest > Rhythms > Pacemakers > Ventricular pacemaker

Ventricular pacemaker

A ventricular pacemaker usually has a lead in the right ventricle. It causes a small sharp spike just before the QRS complex, which will be wide.

See also: Pacemakers

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Excessive discordant ST elevation Pacemaker spikes Ventricular pacemaker 12-Lead Dr Smith's ECG Blog CC BY-NC
Acute chest pain in a patient with cardiomyopathy and a paced rhythm.

This ECG is from a woman in her 70s who was awoken with sharp chest pain on a background of cardiomyopathy, ICD and LVH.

This ECG shows paced rhythm with modified-Sgarbossa positive discordant ST elevation in I, aVL and V2. Angiogram did not find a culprit and echo did not find a wall motion abnormality. The cause remains a mystery.

In the ECGquest archives, this ECG has been tagged with: - Concordant ST depression in V1-V3 Excessive discordant ST elevation Atrial pacemaker Ventricular pacemaker Acute Inferior MI Acute Lateral MI Acute Posterior MI Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
Can you see through this paced rhythm?

This ECG is from an elderly woman who presented with 2 hours of chest pain on a background of multiple stents, a pacemaker, stroke and COPD.

This ECG shows paced rhythm with excessively discordant ST segments (modified Sgarbossa positive). The cause was a 95% thrombotic lesion of the RCA.

In the ECGquest archives, this ECG has been tagged with: - Nonspecific baseline artefact Atrial fibrillation Ventricular pacemaker 12-Lead Dr Smith's ECG Blog K. Wang CC BY-NC
Computer often fails to diagnose atrial fibrillation in ventricular paced rhythm, and that can be catastrophic

This ECG is from an elderly patient who presented with a massive hemiplegic ischemic stroke due to MCA thrombus.

This ECG shows atrial fibrillation with ventricular pacemaker and significant artefact. The AF went undiagnosed.

In the ECGquest archives, this ECG has been tagged with: - Hypotension Pacemaker spikes Wide QRS Ventricular pacemaker Hyperkalemia 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
What will you do for this altered and bradycardic patient? Repeat ECG after transvenous pacemaker

This ECG is from a woman in her 60s who presented from a nursing home with altered mental status, hypotension, hypoxia and bradycardia. This was the repeat ECG after placement of a transvenous pacemaker.

This ECG shows a very wide ventricular paced rhythm with widespread excessive discordant ST elevation. The cause was hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Regular Tachycardia Wandering baseline Excessive discordant ST depression. Excessive discordant ST elevation Pacemaker spikes Wide QRS Ventricular pacemaker Multi-vessel disease 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
Can you see through this wide complex rhythm?

This ECG is from a man in his 70s who presented with intermittent dyspnoea and chest pain over the past 2 weeks. He had a history of a pacemaker, heart failure, aortic stenosis, diabetes, hypertension, stroke, ischemic heart disease, chronic kidney disease and peripheral vascular disease. This was his initial ECG.

This ECG shows a wide complex tachycardia with ventricular pacing. The excessively discordant ST changes in V4-6 and aVR suggested diffuse subendocardial ischemia. He was found to have severe three vessel disease and a proximal left circumflex stenosis was stented.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Concordant ST elevation Inferior ST depression Wide QRS Ventricular pacemaker Limb leads Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

This ECG is from an elderly male who presented with chest pain. He has a pacemaker. This was his first prehospital ECG.

This ECG shows ventricular paced rhythm with concordant STE in aVR and concordant ST depression in II, III, aVF. The cause was most likely a proximal LAD or left main occlusion. This was missed and the patient died.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Concordant ST elevation Excessive discordant ST elevation Wide QRS Ventricular pacemaker Acute Anterior MI Chest leads Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

This ECG is from an elderly male who presented with chest pain. He has a pacemaker. This was his second prehospital ECG.

This ECG shows ventricular paced rhythm with excessive discordant ST elevation in V3 as well as concordant ST elevation in V2 and V4. The cause was most likely a proximal LAD or left main occlusion. This was missed and the patient died.

In the ECGquest archives, this ECG has been tagged with: - Bradycardia Extreme Axis LA/RA electrode reversal Regular Pacemaker spikes Wide QRS Ventricular pacemaker 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 27th August 2018 – Interpretation
In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Discordant ST changes Excessive discordant ST elevation Pacemaker spikes Ventricular pacemaker 12-Lead Dr Smith's ECG Blog CC BY-NC
Patient with Paced Rhythm in Severe Cardiomyopathy Presents with SOB due to Acute Decompensated Heart Failure

This ECG is from a middle-aged male who presented with paroxysmal nocturnal dyspnoea and hypoxia on a background of heart failure, biventricular pacemaker, ICD and previous LV thrombus.

This ECG shows biventricular paced rhythm with RBBB-like morphology and discordant ST elevation in I, aVL, V3-5 due to acutely decompensated heart failure.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Extreme Axis Regular Concordant ST depression in V1-V3 Excessive discordant ST elevation Wide QRS Ventricular pacemaker Positive Sgarbossa criteria 12-Lead Dr Smith's ECG Blog CC BY-NC
Chest pain, Ventricular Paced Rhythm, and a Completely Normal Angiogram 3 Months Prior.

This ECG is from an elderly woman who presented with chest pain on a background of a normal angiogram 3 months prior.

This ECG shows ventricular paced rhythm (likely biventricular) with concordant ST depression in III, aVF and V3. There is excessive discordant ST elevation in I and aVL. The cause was an acute left main occlusion due to suspected embolism.