An Interesting ECG Case

70 year old male presents with presyncope.

What does the ECG show?

Findings:

•Sinus rhythm

•High degree AV block with 3 P waves for 1 QRS

•Left bundle branch block

Tips:

•Remember to map out the p waves in the rhythm strip!

•Sometimes, p waves can be hidden in the T waves

•This patient was referred for a permanent pacemaker given symptoms and high degree AV block