Feedback from the Web:
Tue, 27 Aug 1996
Fromesc ESC@cyber.nl
second degree av-block, normally function of pacemaker

Fri, 30 Aug 1996
From: LCronin427@aol.com
The patient's underlying rhythm is sinus with a second degree A-V block type I (wenckebach). The pacer's lower rate limit appears to be around 50, and after the first QRS, he drops a beat, and the pacer fires appropriately when the LRL is reached. It fires, though, into the patient's own spontaneous QRS, producing pseudofusion. As a single chamber pacer, it can't sense the P wave. Later in the tracing, after a dropped beat, the LRL is reached and he begins pacing at a rate of 50... this time the native QRS didn't show up on time. The pacemaker is working fine, but the underlying AV block needs to be addressed: unless it is due to AV nodal blocking drugs or ischemia, he may need an upgrade to dual-chamber pacing.

Tue, 3 Sep 1996
From: MariRN@aol.com
the underlying rhythm appears to be Wenkebach, the spike on the 2nd QRS looks like failure to sense, while the last 2 beats were properly sensed and paced.

Fri, 06 Sep 1996
From: minihutch@moose.uvm.edu
Underlying rhythm is 2nd degree Mobitz II block. Pace maker is in VVI mode at 50 bpm and is functioning normally. The spike on the second QRS represents a pseudofusion beat.

Wed, 04 Sep 1996
From: kyle@ktn.net
This appears to be a patient in a 1:1 and 2:1 variable degree 2nd degree type II AV heart block. The pacer does not appear to be sensing although it does capture, as witnessed by the last two QRS complexes.

Sat, 7 Sep 1996
From: PNCAUDIO@aol.com
This rhythm looks like a wenckeback or some type of block. The spike on the second QRS looks like the pacemaker is not sensing properly. It looks like the sensing needs to be turned up on this pacemaker. I am a PACU RN and have a interest in cardiac related subjects.

Mon, 9 Sep 1996
From: gmarcum@indy.net ,Henry County Memorial, New Castle
The pt. is having periods of Mobitz 2 , 2 degree A / V block. The Pacer spike, I don't think the pacer is working right. Because the pacer should have fired when the pt. had the pause during the A / V block. Looking at the two beats @ the end of the stripe tells me that the rate is to slow about 50 for the pacer when it does capture.

Mon, 16 Sep 1996
From: mbrook@itsa.ucsf.EDU
Wenkeback Type II AV Block; pacer not working well

Wed, 11 Sep 1996
From: GIMBELJR@ix.netcom.com
The native rhythm appears to be sinus with high grade heart block (evidence of Mobitz II and CHB) Evidence of appropriate sensing but failure to capture intermittently at the current output settings.
Would have put a dual chamber device in.

Thu, 12 Sep 1996
From: jmchugh@crozer.org, Osteopathic Medical Education
The native rhythm appears to be second degree A-V Block, Mobitz type II, a conduction abnormality associated with LBBB, thus incomplete trifascicular block. Pacer appropriately inserted. The "spike" on the second QRS fired WITH the inherent depolarization so no problem.

Sat, 14 Sep 1996
From: u1002689@warwick.net
Rhythm is sinus with second degree (Probably MobitzII) heart block. Single chamber pacer set a 50 PPM. Spike on second QRS could be fusion beat since interval from previous QRS is the same as paced intervals. Patient should have dual chamber PM implanted.