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Option: 3 dual chamber pacemaker
The presence of low voltage with pseudo infarct pattern as well as heart failure with preserved EF/conduction abnormalities might be related to underlying cardiac amyloidosis. Although, I am expecting to see other supportive findings on echocardiogram Including diastolic dysfunction.
The P wave morphology appears to be positive in lead II which supports sinus origin.
if I may ask, is there a cutoff PR interval for AV conduction to occur?
The second question to Dr. Fathi Idris,
How does the width of the P wave help to decide if it is retrograde vs antegrade?
Thank you Dr. Yousef Darrat for sharing with us this case.
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Although voltages are "lowish" in general, but not sure if they meet the criteria of "low voltage" (all limb leads <5mm and all precordial <10mm).
Agree, P wave is probably sinus (but sometime when it is on T, you need to be careful).
In general, retrograde P waves (assuming originating from a backwave below His, is usually skinny as the activation of both atria occur simultaneously starting in the septum area (in the EP lab this is easier to see). However, sinus or other atrial rhythm usually leads to a wider P waves (typically has two components) as the atria are activated sequentially.
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2004 EKG is above, first degree AV block otherwise unremarkable
2018 EKG longer PR interval
Post pacemaker implant
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