ECG 2:1 AV block with long QT interval

A 64 year old female with a known case of Hypertension since last three years comes to JIPMER emergency department with  chief complaints of giddines since last three days with history of one episode of syncope with loss of consciousness for around five minute two days back. Patinet went to private hospital, ECG done was suggestive of bradycardia so she was reffered to JIPMER, Pondicherry, India for further management. Patient was on tab Losartan 50 mg for hypertension. There was no history of beta blocker intake.During evaluation in the emergency department patient pulse rate was 44 per minute, Blood pressure was 110/80 mmhg, CVS =S1S2 were normal, RS-Bilateral equal air entry, there were no additional sound.

ECG of the patient is shown below (Kindly click on the ECG to enlarge it)

Description of the ECG-AV block with 2:1 conduction present at 42 per minute, atrial rate around 84 per minute,For every two P wave there are only two QRS complexes,  normal axis, narrow QRS complex, RBBB morphology, QT interval 600 msec, QTc 502 msec

ECG done at JIPMER Emergency department

Description of the ECG-Heart rate 48 per minute, 2:1 AV block, Incomplete RBBB, normal axis, QT interval 660 msec, QTc 590, T  wave inverion in lead I, II, avF, V1-V6, for every two P wave there are only one QRS complex

Diagnosis of the ECG=2:1 AV block with Long QT(Bradycardia induced)

Patient was admitted in the cardiology department and underwent successful permanent pacemaker implantation.

More ECG of the same patient