[tab_nav type=”two-up”][tab_nav_item title=”Clinical Case” active=”true”][tab_nav_item title=”Answer” active=””][/tab_nav][tabs][tab active=”true”] Time to Play: What’s That Rhythm?! Rhythm Strip Patient is a 60 yr old gentleman with ALS who was admitted for respiratory distress on NIPPV. This picture is representative of his initial rhythm strip upon arrival to the hospital. What’s the deal with those intermittent clustered spikes? Take a long look at it and decide for yourself whether it’s worrisome or not, and what you think might be the etiology. [/tab][tab] This gentleman had a diaphragmatic pacemaker implanted some time ago for his progressive respiratory failure due to his ALS. The intermittent clustered spikes observed on his rhythm strip above are due to his diaphragmatic pacer (DP) firing as intended. Note that the pattern is very repetitive, identical in appearance with each occurrence, and is superimposed on his underlying rhythm without obvious relation to, or impact on, his cardiac rhythm. See link below for further reading on DP in ALS if interested.
Reference: Scherer K, Bedlack RS. Diaphragm pacing in amyotrophic lateral sclerosis: a literature review. Muscle Nerve. 2012;46(1):1-8. [/tab][/tabs]
