Thank you for providing the EKG image. Now I can analyze the tracings for you. Here's what I observe:
Rhythm: The rhythm is regular with a rate of approximately 50 beats per minute, consistent with the information provided earlier.
Pacemaker activity: There are clear pacemaker spikes visible immediately before each QRS complex. This confirms that this is a paced rhythm.
QRS complexes: The QRS complexes are wide (>120ms), which is expected in ventricular pacing. They have a left bundle branch block-like morphology, typical of right ventricular pacing.
P waves: There are no visible P waves preceding the QRS complexes. This suggests that this is a ventricular paced rhythm without atrial sensing or pacing.
T waves: The T waves are large and opposite in direction to the QRS complexes, which is normal for paced beats.
ST segments: There are no concerning ST segment deviations visible.
Lead patterns:
- Lead I shows predominantly positive QRS complexes
- Lead II shows deep S waves followed by tall R waves
- Lead III shows deep S waves similar to Lead II
Interpretation:
This EKG shows a ventricular paced rhythm at 50 beats per minute, likely from a single-chamber (VVI) pacemaker. The pacemaker is functioning appropriately, capturing the ventricles with each spike. There's no evidence of atrial activity, which is consistent with a ventricular-only pacing mode.
This pattern is consistent with what we would expect to see in a patient with an Aveir VR leadless pacemaker implanted in the right ventricle, as mentioned in your previous queries.
Recommendations:
Compare this EKG with previous recordings to ensure stability of the pacing threshold and sensing.
Assess the patient's symptoms and activity level to determine if the pacing rate is appropriate.
Consider a pacemaker check to ensure proper function and battery status.
Evaluate if the patient would benefit from upgrading to a dual-chamber system, especially if they experience symptoms related to lack of AV synchrony.
Remember, while this analysis is based on the visible EKG, clinical decisions should always be made by a qualified healthcare provider considering the patient's full clinical picture.
