EP Quizzes

Question 1: 

Based on this ECG strip, what does this ECG show?
1. Electrode problem or lead change 
2. Ventricular standstill (phase-4 block)
3. Sick Sinus Syndrome (SSS)
4. None of the above

Question 2: 

Based on this ECG strip, what does this ECG show?
1. Run of VT
2. Pacemaker 
3. AIVR with fusion beats
4. None of the above

Question 3: 

Based on this 12-lead ECG, what does it show?
1. Sino-atrial Wenckebach
2. Atrial bigeminy 
3. Atrial trigeminy 
4. None of the above

Question 4:

Based on this 12-lead ECG, what does it show?

Answer to Question #1: 

This ECG rhythm strip shows ventricular standstill initiated by a non-conducted atrial premature beat. This is often known as ‘phase 4 block,’ or paroxysmal AV block, and was initiated by a non-conducted atrial premature beat. 

Answer to Question #2:

This ECG rhythm strip shows sinus rhythm transitioning into a slightly faster accelerated idioventricular rhythm (AIVR). There appear to be at least 9 consecutive ventricular fusion beats of increasing progression. The P-R interval is foreshortening as the QRS complex gets wider. The differential diagnosis would be the so-called “concertina” effect in patients with WPW syndrome, where there is progressively increasing ventricular preexcitation. In such cases, the QRS complex would get wider at the expense of the P-R interval shortening.

Answer to Question #3: 

This 12-lead ECG shows that every third beat is an atrial premature beat, so this is so-called atrial “trigeminy.”

Answer to Question #4: 

This is piggyback heart transplant.