What Do You Think 9

97-year old semi-retired, one-legged grave digger with “one foot in the grave”, but which one?

What do you think?

Think before proceeding.

• V1, sinus rhythm.
• Bigeminal atrial ectopics with increasing aberration in the right bundle branch. No aberration (red highlight), incomplete aberration (yellow highlight) and blocked conduction (blue highlight).

Atrial bigeminy with Wenckebach AV block sequence in the right bundle branch.

Can also occur within a triplet.

• V1, sinus rhythm
• Atrial ectopic (red highlight).
• Atrial triplet with first two beats demonstrating increasing aberration because of prematurity (yellow highlight). The first beat demonstrates some conduction in the right bundle, the second is a complete block and the third is delayed with recovery in the right bundle branch (blue highlight).  

It’s all in the timing!