How to Read a Pacemaker ECG

00:01 And here we see an ECG with pacing spikes.

00:04 Let's take - look at the bottom which is the rhythm strip.

00:07 Okay. The first beat, the first QRS has a spike in front of it, so it's paced.

00:13 The second beat with the green box is just like that. There's a spike and a QRS.

00:18 The next beat; the third beat, spike and QRS. The next, spike, QRS, spike, QRS, spike, QRS.

00:28 Oh, a normal beat and then another normal beat. And then, spike, QRS, spike, QRS, spike, QRS.

00:38 You see this pace - in this pacemaker, in this patient was appropriately inhibited when there were two normal beats that occurred.

00:46 So, this is an EKG from a patient who is being continuously atrial and ventricular paced.

00:53 Notice particularly look at the top line.

00:57 This is a regular 12 lead ECG. Look at lead I, two paces are spikes; one, where the atrium was and one for the ventricle.

01:04 And then as you move across to aVR, again, two spikes, atrial and ventricle.

01:09 You move across to V1, two spikes, atrial and ventricle and then across to V4, two spikes, atrial and ventricle.

01:16 So this is a patient being continuously paced, atrially and ventricularly.

01:21 So this is almost certainly a DDD pacemaker. Here, we see atrial pacing.

01:28 Notice, there's a spike and a P-wave and a normal QRS with no spike.

01:33 The next beat, an atrial spike and a normal QRS.

01:37 Atrial spike covered in the green box and on the next - those two beats - the green box will show you the atrial spike for the pacemaker impulse, a P-wave and then a normal QRS.

01:50 So this is atrial pacing. No ventricular pacing here.