7.8.12 Ventricular escape beats
Ventricular escape beats are similar to junctional escape beats except that the impulse starts within the ventricular myocardium. Because depolarisation does not follow normal pathways, it results in a QRS complex which differs from normal and may be wide and bizarre. A ventricular escape beat is indicative of a failure of the sinoatrial node, atria or junctional tissue to adopt the pacemaker role or of the AV node to conduct a sinus impulse. The escape beat itself is a normal response to the failure of activation and does not require treatment. However, investigation of underlying causes of atrial or junctional disease is advisable. Ventricular escape rhythms have a slow, regular rhythm. The ECG will show an absence of P waves, or non-conducted P waves which have no relato the regularly spaced, abnormal QRS complexes.