Scenario: The top strip was obtained in an 83-year-old woman admitted to the coronary care unit with intermittent chest pain just before going to the cardiac catheterization laboratory for percutaneous coronary intervention (PCI). The patient has a history of coronary artery disease and a permanent pacemaker. The bottom strip was taken upon return to the coronary care unit after a stent was placed in the right coronary artery. The patient was complaining of chest pain, which started during the PCI procedure and never resolved.

Interpretation: (Top Strip) Atrioventricular pacing at 69 beats per minute (bpm) with 1 premature ventricular complex. (Bottom Strip) An intrinsic atrial rhythm is present with ventricular pacing at 72 bpm. The QRS morphology is different, with new ST-segment elevation suggestive of acute inferior myocardial infarction (MI).

In patients with right ventricular paced rhythms (VPR), the endocardial electrode generating the impulse is positioned in the right...

You do not currently have access to this content.