The recording shows a regular heart rate of 50 BPM, which aligns with the lower rate limit typical for a pacemaker setting. The rhythm displays wide QRS complexes, consistent with ventricular pacing (specifically from the Right Ventricle). The "Unclassified" determination is a common result for paced rhythms as the algorithm often does not categorize wide complexes as Normal Sinus Rhythm.
Observation: The QRS complex is predominantly positive (upward deflection)[cite: 21].
Opinion: This indicates the electrical vector is traveling from right to left. In the context of a pacemaker, this suggests the impulse originates in the right ventricle and spreads toward the left side of the heart. [cite_start]The Kardia determination is primarily calculated on this lead[cite: 10].
Observation: These leads show deep negative complexes (downward deflection)[cite: 21].
Opinion: A negative deflection in the inferior leads indicates a "Superior Axis." The electrical signal is moving away from the bottom of the heart and traveling upward. This is the classic signature of a leadless pacemaker situated in the apex of the right ventricle, pacing upwards.
Observation: The QRS complex is predominantly positive[cite: 21].
Opinion: In a normal intrinsic rhythm, aVR is negative. A positive aVR here confirms the signal is traveling upward and to the right, further supporting a ventricular origin for the heartbeat (pacing).
Observation: The QRS complex is positive/isoelectric[cite: 21].
Opinion: Consistent with Lead I, this confirms the leftward movement of the electrical forces.
The ECG displays a Left Bundle Branch Block (LBBB) pattern with a Superior Axis. This is the expected and normal electrical pattern for a patient with a functioning Right Ventricular pacemaker. There is 100% capture at 50 BPM with no visible pauses or malfunction.