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Severe SA and AV Nodal Dysfunction with a Long Ventricular Pause

Description

ECG from a patient with severe SA and AV nodal dysfunction. The underlying rhythm is sinus bradycardia with a rate of 28/min. Either complete heart block or high degree AV block with 4:1 conduction is present. Four P waves are recorded. The first three are not conducted. It is uncertain whether the fourth P wave is conducted; the QRS complex that follows this P wave may be conducted with a very long AV delay (PR interval is 440 msec) or it may be a junctional escape complex following a non-conducted P wave. The same is true of the first QRS complex in this recording. The result of the AV nodal conduction abnormality is an 8.5 second ventricular pause. Additional findings are diffuse T wave inversion and QT interval prolongation.

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