Do you ever feel confused by pacemaker rhythms?  You are not alone!   Pacemakers are electronic devices, and have rapidly evolved in their capabilities.  Often, we call the manufacturer's representative to come and interrogate a patient's pacemaker to determine if it is behaving as it was programmed.  Without knowing the programming of the individual pacemaker, it can be hard to evaluate the patient's rhythm.

I write a lot about teaching students at different levels.  I believe you have to teach at a level your students will understand, but also raise them up from the understanding they currently have. I am asked to teach a lot of "refresher" classes, but I always hope each student leaves with some NEW information.  My mentor, Donna Harden, often admonished me that I was "teaching at a level that was too basic".   I laughed and told her that I had a successful business preparing people to take HER classes!

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Once your students have mastered the basic rhythms and their criteria, many of them will want to try more challenging rhythms.  Non-conducted premature beats, retrograde conduction, AV blocks, and concealed conduction can be easily explained using LADDERGRAMS.  A laddergram is a diagram of a rhythm strip showing the timing and conduction of the electrical impulses.  There is a line drawn for the atrial activity, one for ventricular activity, and one for AV activity.  Blocks and retrograde conduction can be easily shown