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Fragment of the ECG was recorded on the 12 leads Holter monitor ( Fig. 1).
Speed of the recording – 25 mm/s.
The permanent pacemaker in DDD mode was implanted to patient.
There are 5 morphologies of PQRST seen on this ECG.

Figure 1. Multichannel Holter ECG recording

ECG - electrocardiogram

The correct description of the PQRST complexes (showed by order of numbers below) morphology on this ECG is:

A) 1,2 – atria: sinus rhythm, ventricles: paced rhythm;
 3 – atria: premature beat, ventricles: paced rhythm;
 4,5 – atria paced rhythm, ventricles: impulse conducted via AV node with LBBB;
 6 – atria and ventricles – fusion beat;
 7,8 – atria and ventricles – sinus rhythm with incomplete LBBB.

B) 1,2 – atria: paced rhythm, ventricles: impulse conducted via AV node with RBBB;
 3 – atria: premature beat, ventricles: impulse conducted via AV node with RBBB;
 4,5 – atria: paced rhythm, ventricles: impulse conducted via AV node with LBBB;
 6 – atria and ventricles – fusion beat;
 7,8 – atria and ventricles – sinus rhythm with incomplete LBBB.

C) 1,2 – atria: paced rhythm, ventricles: impulse conducted via AV node with RBBB;
 3 – atria: premature beat, ventricles: impulse conducted via AV node with RBBB;
 4,5 – atria sinus rhythm, ventricles: impulse conducted through accessory pathway;
 6 – atria and ventricles – fusion beat;
 7,8 – atria and ventricles – sinus rhythm with incomplete LBBB.

D) 1,2 – atria: paced rhythm, ventricles: impulse conducted via AV node with RBBB;
 3 – atria: premature beat, ventricles: impulse conducted via AV node with RBBB;
 4,5 – atria:  paced rhythm, ventricles: paced rhythm;
 6 – atria and ventricles – fusion beat;
 7,8 – atria and ventricles – sinus rhythm with incomplete LBBB.

 

Mykhaylo Sorokivskyy
 Lviv Regional Cardiology Center,
Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
Peer-review: Internal
 Conflict of Interest: None to Declare
Authorship: M.S.
 Acknowledgement and funding: None to declare