Complete congenital heart block: A case of multilevel block

Figures

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  Figure 1. Initial electrocardiogram post dual-chamber pacemaker placement at 2× gain demonstrating atrial-sensed ventricular-paced rhythm at 93 beats per minute (bpm), noncaptured P waves at a rate of 112–120 bpm, and low-amplitude left atrial impulse prior to every QRS complex. (Arrows indicate left atrial impulse.)

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  Figure 2. Rhythm strip from pacemaker interrogation at 5-month outpatient visit. Strip demonstrates initial variability in heart rate (top row) and by the end of the strip (lower row) there is loss of spontaneous left atrial activity and accelerated junctional rhythm. Nonconducted P waves march through the entirety of the strip at a rate of 150 beats per minute. (Arrows indicate right atrial impulse.)

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  Figure 3. Rhythm strip from pacemaker interrogation at 5-month outpatient visit, during which the lower rate of the pacemaker was temporarily programmed at 160 beats per minute (bpm), demonstrating P waves continuing to march through at a rate of 150 bpm. Left atrial capture observed after atrial pacing spike. (Arrows indicate right atrial impulse.)