Weekly EP & ECG rounds at the BIDMC (Archive)

Editors-In-Chief: Chris Pickett,M.D. [mailto:cpickett@bidmc.harvard.edu]; Peter Zimetbaum, M.D. [mailto:pzimetba@bidmc.harvard.edu]; Mark Josephson, M.D.[mailto:mjosphson@bidmc.harvard.edu]

August 2007
'''This patient is a 53 year old woman with a history of SVT who is referred for an electrophysiology study due dyspnea with exertion and a Holter ECG which showed several episodes of AV block second degree with 5:4, 4:3, and 3:2 conduction, as well as brief episodes of a junctional rhythm during the daytime. Prior to her EP study, she underwent stress testing and exercised 4 minutes on a BRUCE protocol, during whch she developed AV Wenckebach block and the test was stopped. She never has had an episode of syncope.'''

This is the baseline ECG:

Her baseline intracardiac recording shows:

This is her intracardiac recording with atrial pacing:

Click here for the answer.