Some years back, I was asked to interpret this ECG, during rounds in the coronary care unit.The patient had been admitted the night before with high degree atrio-ventricular block and required temporary pacing.

This is an old pacing ECG, which has a number of interesting features. It was performed two hours after the implant.

We have previously discussed physiologic ventricular aberration with atrial ectopy or atrial fibrillation with a rapid ventricular response. There is another type of ventricular aberration, which is slower and represents abnormal bundle branch physiology. This is a rate dependent bundle branch block.

AV with slow ventricular response. The rate is 40BPM. In the good old days this was digitalis toxicity until proven otherwise. The clue is Bifascicular block. Many cardiologists are reluctant to call this complete heart block as there is no AV dissociation.Don’t be scared to call this complete heart block because that is what it is!!

This week we had a Holter monitor recording reported as complete heart block. For obvious reasons this can be a serious diagnosis, but the reporting cardiologist felt it was Wenckebach sequences and requested a review.

Vagal Hypertonia is a topic that is often confusing and misunderstood. And although we have touched on the topic briefly in the past, Dr Harry Mond delves a little deeper in a bid to clear up any confusion.

While the QT Interval is a topic that few Cardiologists are experienced in, we review several aspects including how it can be measured, while discussing some of the surrounding controversies.

The shock of Ping-Pong in the His-Purkinje system combined with severe digitalis toxicity is the discussion of this rare trace discovered at CardioScan. Medical Director Medicine Dr Harry Mond shares what it reveals and the talks about the changing treatment regimes for such a case.

Dr Harry Mond explores the various arrhythmic events that can interrupt and terminate Wenckebach AV sequences including non-conducted atrial ectopics.