McGill Case 170

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This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia.

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This is a series of tracing from a man with severe obstructive lung disease, congestive heart failure and uncontrollable atrial fibrillation. The tracings were taken in the ICU and record the effect of cardioversion for atrial fibrillation that was required to facilitate A/V nodal ablation. The first tracing is before the shock was delivered.
The patient had a Medtronic Model 8081 unipolar pacemaker implanted a few days before the cardioversion. Cardioversion was done with 50 joules with anterior and posterior pads to place the axis of the shock perpendicular to that of the pacemaker and the tip of the pacing lead.
The patient was then given a second shock of 360 joules and the rhythm below resulted
The patient then recovered his own rhythm below.

The final strip shows the patient's rhythm after A/V nodal ablation. (after which he dramatically improved and was able to leave the ICU).