McGill Case 325

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. Previous Case: McGill Case 324 | Next Case: McGill Case 326

This is a cardiogram from a middle aged man with palpitations. The patient had a dual chamber pacemaker (Vista) set at a lower rate of 60/min, and upper rate of 100/min. The patient had developed atrial flutter, and the pacemaker was following this with a 3:1 block. The flutter is seen in the second panel where the pacemaker was set to a VVI mode and a rate of 30/min. Note that in the first tracing the pacer spikes are not well seen as the pacemaker is pacing in a bipolar mode.