Scenario: This ECG (lead II) was obtained in a 4-month-old infant with transposition of the great arteries who had surgical repair for arterial transposition and ventricular septal defect. The postoperative course was complicated by occlusion of both the right and circumflex coronary arteries. Following surgical repair of both coronary arteries as well as a mitral valve repair due to a papillary muscle infarct, the patient returned to the intensive care unit. The patient was receiving continuous sedation. At the time of this recording, the patient’s heart was being paced via epicardial wires, using a temporary external pacemaker. The atrial demand rate was set at 140 beats per minute (bpm). This patient’s pacemaker was configured as AAI, with the first letter indicating chamber paced (A), second letter chamber sensed (A), and the third letter indicating response to the sensed event (I). The bedside nurse noticed a rapid nonsustained cardiac dysrhythmia...
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1 November 2018
ECG Puzzler|
November 01 2018
Cardiac Dysrhythmia During Pacing in an Infant
Ashlee Shields, MSN, RN, CCRN;
Ashlee Shields, MSN, RN, CCRN
Ashlee Shields is a programmatic nurse specialist, Acute and Critical Cardiac Care, Children’s Hospital of Pittsburgh of UPMC. Salah S. Al-Zaiti is an assistant professor at the Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Teri M. Kozik is a nurse researcher at St Joseph’s Medical Center, Stockton, California. Michele M. Pelter is an assistant professor in the Department of Physiological Nursing, University of California, San Francisco, California. Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.
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Salah S. Al-Zaiti, PhD, RN, CRNP;
Salah S. Al-Zaiti, PhD, RN, CRNP
Ashlee Shields is a programmatic nurse specialist, Acute and Critical Cardiac Care, Children’s Hospital of Pittsburgh of UPMC. Salah S. Al-Zaiti is an assistant professor at the Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Teri M. Kozik is a nurse researcher at St Joseph’s Medical Center, Stockton, California. Michele M. Pelter is an assistant professor in the Department of Physiological Nursing, University of California, San Francisco, California. Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.
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Teri M. Kozik, PhD, RN, CNS, CCRN;
Teri M. Kozik, PhD, RN, CNS, CCRN
Ashlee Shields is a programmatic nurse specialist, Acute and Critical Cardiac Care, Children’s Hospital of Pittsburgh of UPMC. Salah S. Al-Zaiti is an assistant professor at the Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Teri M. Kozik is a nurse researcher at St Joseph’s Medical Center, Stockton, California. Michele M. Pelter is an assistant professor in the Department of Physiological Nursing, University of California, San Francisco, California. Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.
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Michele M. Pelter, PhD, RN;
Michele M. Pelter, PhD, RN
Ashlee Shields is a programmatic nurse specialist, Acute and Critical Cardiac Care, Children’s Hospital of Pittsburgh of UPMC. Salah S. Al-Zaiti is an assistant professor at the Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Teri M. Kozik is a nurse researcher at St Joseph’s Medical Center, Stockton, California. Michele M. Pelter is an assistant professor in the Department of Physiological Nursing, University of California, San Francisco, California. Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.
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Mary G. Carey, PhD, RN, CNS
Mary G. Carey, PhD, RN, CNS
Ashlee Shields is a programmatic nurse specialist, Acute and Critical Cardiac Care, Children’s Hospital of Pittsburgh of UPMC. Salah S. Al-Zaiti is an assistant professor at the Department of Acute and Tertiary Care Nursing, University of Pittsburgh, Pennsylvania. Teri M. Kozik is a nurse researcher at St Joseph’s Medical Center, Stockton, California. Michele M. Pelter is an assistant professor in the Department of Physiological Nursing, University of California, San Francisco, California. Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York.
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Am J Crit Care (2018) 27 (6): 519–520.
Citation
Ashlee Shields, Salah S. Al-Zaiti, Teri M. Kozik, Michele M. Pelter, Mary G. Carey; Cardiac Dysrhythmia During Pacing in an Infant. Am J Crit Care 1 November 2018; 27 (6): 519–520. doi: https://doi.org/10.4037/ajcc2018246
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