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All ECG 42

The ECG shows normal sinus rhythm at about 100 beats per minute (bpm) without any evidence of atrioventricular conduction (ie, complete heart block). The ventricular rhythm is paced at a rate of about 90 bpm. There are no R waves in the chest leads, and the ST segments are upsloping and elevated in V1-6.

There are no firm criteria for the ECG diagnosis of an anterior myocardial infarction in the setting of a paced rhythm. However, at angiography this patient had an acute occlusion of the proximal left anterior descending coronary artery. 

ST segments in V4 and V5 in this tracing are dramatically elevated with a shape different from a normal paced QRS-T morphology (left bundle branch block pattern). This ECG meets Sgarbossa’s criteria; however, it has not been validated in a paced rhythm (see Left Bundle Branch Block ECG Review; link below).

Related Topic Reviews: Anterior MI ECG Review, Left Bundle Branch Block