case_images: PMC3543718_01
case_images: ECG findings.Upper panel, rhythm strip (lead II) immediately after the intravenous injection of epinephrine, showing a heart rate of 187 bpm, multifocal atrial tachycardia and ST elevation of 4 mm. Notice the different P-wave morphologies; flat (junctional), negative and positive p-waves are evident (arrows). Lower panel, ECG (leads II and V5) two months later showing a ventricular rate of 115 bpm and persistent wandering atrial pacemaker. The same findings were present at 12 and 18 months.
case_images: 1471-2431-13-1-1.jpg
case_images: PMC3543718_01_1471-2431-13-1-1.jpg
case_images: F1
case_images: The QRS complex <= 100 ms and ST-segment elevation >= 3 mm were evident on the rhythm strip (Figure 1, upper panel). ECG (Figure 1, lower panel) and 24-hour Holter tape recording at 2, 12 and 18 months showed persistent wandering pacemaker with normal QRS duration and ventricular rate (about 100 bpm).