Wide QRS complex rhythm with pulseless electrical activity

Abstract

Wide QRS complex rhythm with pulseless electrical activityA 64-year-old man with chronic kidney disease and recent upper gastrointestinal hemorrhage suffered pulseless electrical activity and cardiac arrest. Cardiopulmonary resuscitation was started, with three attempted but failed electrical cardioversions. Return of spontaneous circulation required prolonged resuscitation efforts, including multiple rounds of epinephrine, calcium, and sodium bicarbonate. The standard 12-lead electrocardiogram (FIGURE 1) showed an irregular wide-QRS-complex rhythm, with right bundle CLEVELAND