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23-26: Ventricular Escape Rhythm

Maite A. Huis in ‘t Veld; Amal Mattu; R. Jason Thurman

ECG Findings

  • Bradycardia, typically with a rate of 20 to 40 bpm.

  • The QRS complex is wider than 120 ms.

  • Can have LBBB or RBBB morphology.

Pearls

  1. When the atria and the AV node fail to initiate a cardiac rhythm, or when no pacing signal reaches the ventricle, the ventricular tissue usually picks up the pacemaking responsibility.

  2. P waves may also be conducted retrograde and buried in the T wave.

FIGURE 23.26A

Ventricular Rhythm with Retrograde P Waves. (ECG contributor: James V. Ritchie, MD.)

An E C G tracing with 12 leads demonstrates a ventricular rhythm with retrograde P waves.
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FIGURE 23.26B

Wide-complex (double arrow) regular QRS at a rate of approximately 50 bpm. Retrograde P waves are seen in this example (arrow).

An E C G tracing of a lead consists of a peak, a small, curved peak, and a small, curved dip. A double-headed arrow is across the peak. An arrow points down to the curved peak.
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