Two pacing spikes each beat: one before the P wave, one before the wide QRS.
What to look for
Two spikes every beat: one before the P wave, and one after the AV delay, in front of a wide paced QRS. Both chambers are paced, and both capture.
Examples
Each strip is 6 seconds of lead II, drawn to scale (25 mm a second, 10 mm a millivolt), so you
can count boxes the way you would on paper. Each one is a different example, measured below it.
Example 1 · lead II · 6 seconds
Rate
57/min, the pacing rate6 QRS complexes in 6 seconds × 10 = 60/min
Rhythm
Regular
P waves
Paced: a spike, then a P wave
P to QRS
1:1, a paced P, then a paced QRS after the AV delay
PR
None to measure
QRS
0.15 s, wide
Pacing
DDD at 57/minEvery spike captures
Example 2 · lead II · 6 seconds
Rate
93/min, the pacing rate10 QRS complexes in 6 seconds × 10 = 100/min
Rhythm
Regular
P waves
Paced: a spike, then a P wave
P to QRS
1:1, a paced P, then a paced QRS after the AV delay
PR
None to measure
QRS
0.16 s, wide
Pacing
DDD at 93/minEvery spike captures
Example 3 · lead II · 6 seconds
Rate
89/min, the pacing rate9 QRS complexes in 6 seconds × 10 = 90/min
Rhythm
Regular
P waves
Paced: a spike, then a P wave
P to QRS
1:1, a paced P, then a paced QRS after the AV delay
A pacing spike before every P wave, each followed by a narrow QRS.
Want a new strip every time? The ECG Drill in the app draws a fresh, measured example on every
try and steers you toward the rhythms you miss. It's part of the Paramedic level, and you can
try 5 strips a day free.
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