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

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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
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.
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.
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.
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.
T wave inversion across chest leads (beyond V3), the most common finding in ARVC.
VT from RV base or septum (not RVOT).
Intermittent Pre-excitation
Consider ablation only if symptomatic or in a high-risk occupation.
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.
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.
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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