ECG Challenge: A shocking revelation!

EMS is called to the residence of a 70-year-old male whose ICD had reportedly discharged.

At the time of EMS arrival the patient is found sitting up in bed. He appears anxious and says, "It just happened again! Right after you knocked on the door! Don't let me die!"

Past medical history: Hypertension, dyslipidemia, heart failure, atrial fibrillation, myocardial infarction, ventricular arrhythmias, cardiac ablation, pacemaker and implantable cardioverter-defibrillator

Medications: Numerous, including Aspirin, Simvastatin (Zocor), Flecainide (Tambocor), Atenolol (Tenormin), Spiranolactone (Aldactone), Warfarin (Coumadin)

The patient is alert and oriented to person, place, time and event. He states that he was awoken from sleep by the ICD shocks and has been shocked three times.

The skin is pale and diaphoretic. Radial pulses are strong and regular. Breath sounds are clear bilaterally.

Vital signs are assessed.

  • RR: 18
  • HR: 68
  • NIBP: 138/91
  • SpO2: 94 on RA
  • Temp: 98.3 F

The cardiac monitor is attached.

A 12-lead ECG is obtained.

What is your interpretation of this 12-lead ECG?

How would you treat this patient?

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