A ‘bizarre’ case of dual chamber pacing with an 80ms AV delay, called us for a second opinion! With examples of a) Atrial pacing at 50 bpm and prolonged AV delay b) Wenckebach AV block; & Ventricular paced beat after 2 secs, we deep dive into the relationship between atrial and ventricular pacing.

Seen for the first time, the pattern in this 24hr histogram gives instantly recognisable clues about what is happening, even without looking at the tracings. Normally, we see a diurnal pattern of rate changes during the day with lower rates at night, but rarely a straight line, unless there is complete heart block (slow) or a regular continual rapid tachyarrhythmia (fast). This, however, is both fast and slow, so what is the diagnosis? We take a closer look to uncover the result.

Showing a number of 2.8 second nocturnal pauses and bundle branch block, this latest case begs the question: is this high degree AV block and does the patient need a pacemaker? Using 11 difference traces, Assoc Prof Harry Mond delves into the topic of Wenckebach and Non-conducted Atrial Ectopics, reminding us of the differences between termination and extension, and that atrial and ventricular ectopics terminate a Wenckebach sequence differently!

First thoughts on this Holter tracing was artefact, but the native rhythm showed a regular pattern of irregularity! Taking a close look at overnight tracings when the rhythm would be slow and the “artefact” less likely, revealed what was really going on. In this case MD Assoc Prof Harry Mond looks at non-physiologic atrial pacing together with major objections to single lead rate adaptive atrial pacing and why this case is CANNOT be AAI pacing with a ventricular minimisation pacing algorithm.

Not all ECG recordings are straightforward, as illustrated by this "bizarre" ECG. In this latest edition in our clinical case studies series, our Medical Director Dr Harry Mond explains how he assessed an ECG he was asked to look at, and how eliminated incorrect solutions to the symptoms being presented.

The presentation of pseudo Wolff-Parkinson-White Syndrome recently had an international customer return a report with a note pointing out that we had missed the diagnosis of intermittent pre-excitation - the Wolff-Parkinson-White Syndrome. But as Assoc Prof Harry Mond explains in this latest cardiac case study, it is not what it seems. He reveals where the confusion lies, and how to come to the correct diagnosis.

This is one that is sure to spark conversation as a topic we know little about. Assoc Prof Harry Mond suggests some may even disagree with his view, and invites you not to hesitate to make some noise!

Dr Harry Mond visits Pacemaker Mediated Tachycardia and explores the two types of programmable algorithms, 'prevention detection' and 'intervention' for its successful treatment.

Dr Harry Mond compares the well defined and easily identifiable ECG appearances of pacemaker-ventricular block and pacemaker-atrial block and how it allows us to interpret even the most bizarre pacing ECGs.