Top 10 Tracings
You Must Know before the Exam
device tracings • egms • ecgs

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#1
Railroad Sign
T wave oversensing
T wave oversensing causing suboptimal BiV pacing
Inappropriate shock from R wave double counting
Far field R wave oversensing w/ V bigeminy
#2
Noise in Device Tracings
EMI from Electrical Saw
Lead Fracture
Defibrillation SVC-RV Shock Coil Reversal
DDx: Conductor Fx, Loose set screws, or Insulation breach.
#3
Noise in ECG Tracings
Moving artifacts with 'Notch' sign.
Moving artifacts. Always look at all leads.
Sinus rhythm with moving artifacts.
Pause artifacts. QRSs did not end with T waves.
#4
Ventricular Premature Beat (VPB) that terminated SVT.
His synchronous VPB without retrograde atrial depolarization terminated SVT. AVRT is most likely.
Similar tracing to the previous. AT & AVNRT can be excluded.
VPB was not His synchrounous. SVT was terminated without A. AT was excluded. AVNRT & AVRT remained possible.
VPB was not His synchrounous. SVT was terminated with A. AT, AVNRT, & AVRT remained possible.
#5
Entrained or Not Entrained
V pacing during VT
Not Entrained. V rate was unchanged.
Not Entrained. A rate was unchanged.
SVT was terminated and reinitiated -- NOT entrained.
Entrained with psuedo V-A-A-V response.
#6
ARVC
T wave inversion across chest leads (beyond V3), the most common finding in ARVC.
VT from RV base or septum (not RVOT).
#7
Intermittent Pre-excitation
Consider ablation only if symptomatic or in a high-risk occupation.
#8
Managed Ventricular Pacing
AAI-DDD mode switch. Noted with AP without VS followed by AP-VP with a very short AV delay.
Long-short sequence from MVP algorithm induced VT.
#9
2:1 AV Block with P waves hidden in T waves
Noted with strange-looking T waves in aVF.
Noted with strange-looking T waves in V1-V3.
#10
During RF Ablation of Slow Pathway
Junctional rhythm with no retrograde A. Ablation needed to be terminated.
Prolonged VA conduction followed by AV block after RF terminated.
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