PMC10440106_01
(a) is the ECG on arrival that illustrates a third degree atrioventricular (AV) block. The red and black arrows show the p waves and QRS complexes respectively. Blue arrows indicate ST depressions. The P-P interval is constant. (b) is the ECG after temporary pacemaker placement at 75 beats per minute. Black arrows show pacing spikes, whereas red arrows indicate the Left bundle brach block morphology of QRS consistent with the pacing of right ventricle. (c) is the ECG when temporary pacemaker was switched off. This demonstrates complete AV dissociation with black arrows depicting atrial rate of 75/min independent of ventricular rate of 38/min as shown by red arrows.
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AV dissociation and ST segment depressions in leads I, II, and avL (Figure 1(a)). A paced rhythm was achieved, and the rate was set to 75 bpm (Figure 1(b)). The patient remained TPM dependent for 1 week (Figure 1(c)) with no return of normal spontaneous rhythm.
Echocardiogram in apical four chamber view showing good left ventricular contractility (a) and the electrode of temporary pacemaker (yellow arrow) in the right ventricle (b).
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His ejection fraction, systolic function, and valve anatomy were normal with no evidence of congenital heart disease on the echocardiogram (Figure 2).