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.

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ECG Library (43)

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In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Weakness 12-Lead Concordant ST depression in V1-V3 Concordant ST elevation Pacemaker spikes Wide QRS Ventricular pacemaker Acute Lateral MI Positive Sgarbossa criteria Dr Smith's ECG Blog CC BY-NC
Elderly with Paced Rhythm, Possible Ischemic symptoms, and an Equivocal Smith Modified Sgarbossa ECG 31386

This ECG is from a woman in her 80s who presented with a couple of days of shortness of breath, weakness and diaphoresis.

This ECG shows ventricular paced rhythm with concordant ST elevation V5-6 and concordant ST depression in V3. The cause was an occlusion of the circumflex.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Excessive discordant ST elevation Pacemaker spikes Ventricular pacemaker Dr Smith's ECG Blog CC BY-NC
Acute chest pain in a patient with cardiomyopathy and a paced rhythm. 30408

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: - 12-Lead 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 Dr Smith's ECG Blog CC BY-NC
Can you see through this paced rhythm? 30424

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: - 12-Lead Nonspecific baseline artefact Atrial fibrillation Ventricular pacemaker Dr Smith's ECG Blog CC BY-NC
Computer often fails to diagnose atrial fibrillation in ventricular paced rhythm, and that can be catastrophic 29617

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 12-Lead Pacemaker spikes Wide QRS Ventricular pacemaker Hyperkalemia Dr Smith's ECG Blog CC BY-NC
What will you do for this altered and bradycardic patient? Repeat ECG after transvenous pacemaker 29338

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 12-Lead Wandering baseline Excessive discordant ST depression. Excessive discordant ST elevation Pacemaker spikes Regular Tachycardia Wide QRS Ventricular pacemaker Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Can you see through this wide complex rhythm? 28777

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 Limb leads Concordant ST elevation Inferior ST depression Wide QRS Ventricular pacemaker Dr Smith's ECG Blog CC BY-NC
Anterior MI in paced rhythm, dismissed by cardiologist, patient died. 27556

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 Chest leads Concordant ST elevation Excessive discordant ST elevation Wide QRS Ventricular pacemaker Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Anterior MI in paced rhythm, dismissed by cardiologist, patient died. 27755

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: - 12-Lead LA/RA electrode reversal Bradycardia Extreme Axis Pacemaker spikes Regular Wide QRS Ventricular pacemaker ECG of the Week CC-BY-NC-SA
ECG of the Week – 27th August 2018 – Interpretation 26730
In the ECGquest archives, this ECG has been tagged with: - Dyspnoea 12-Lead Discordant ST changes Excessive discordant ST elevation Pacemaker spikes Ventricular pacemaker Dr Smith's ECG Blog CC BY-NC
Patient with Paced Rhythm in Severe Cardiomyopathy Presents with SOB due to Acute Decompensated Heart Failure 25168

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 12-Lead Concordant ST depression in V1-V3 Excessive discordant ST elevation Extreme Axis Regular Wide QRS Ventricular pacemaker Positive Sgarbossa criteria Dr Smith's ECG Blog CC BY-NC
Chest pain, Ventricular Paced Rhythm, and a Completely Normal Angiogram 3 Months Prior. 22362

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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Anterior ST elevation Concordant ST elevation Excessive discordant ST elevation Left Axis Deviation Normal rate Pacemaker spikes Wide QRS Ventricular pacemaker Acute Anterior MI ECG of the Week CC-BY-NC-SA
ECG of the Week – 25th December 2017 – 60 min later 16356

This ECG is from a woman in her 80s who presented with chest pain. She had a history of 2nd degree AV block with PPM in-situ. This repeat ECG was recorded 60 min after presentation when she had further chest pain.

This ECG shows ventricular pacing with concordant ST elevation in I and V6, and excessive discordant ST elevation in V2-4. The cause was an acute anterior MI.