Wide Complex Rhythms

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    70 year old unresponsive in the CCU.

    70 year old unresponsive in the CCU.

    Key Findings

    - Agonal paced rhythm likely

    - Severe QRS widening compatible with acidosis and severe hyperkalemia

    - LVAD motor artifact

    Coding for the Boards

    - Artifact

    - Ventricular pacer normally functioning

    Answers

    Discussion: This is a V paced rhythm in a person with an LVAD. This noise is characteristic of LVAD noise. Severe hyperkalemia affects QRS duration because of its indirect inactivation of sodium channelsdue to generalized depolarization.