Emergency Cases Northwest Group

022 Repolarization? What’s that?

Situation

Transcutaneous pacing caused a false electrical capture but increasing the energy led to actual capture.

Background

An elderly man arrived with HR of <30, in collapsed state. Pacing commenced with what looked like electrical capture but the pulse remained slow. Only increasing the energy changed the complexes on the monitor and caused an actual electrical capture.

Assessment

What first appeared to be electrical capture was just electrical artefact from the pacing. Only the presence of ventricular polarization signalled real electrical capture.

False electrical capture looks like this (ie not convincing of any ventricular repolarization/ t waves):

Our patients trace looked like this (ventricular repolarization now present in the form of inverted t waves) real electrical capture:

Real electrical capture can also look like this:

Recommendation

When pacing look for evidence of ventricular repolarization before you declare electrical capture, you need to keep increasing the energy until you achieve it.



PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group