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1301 we observed the increase in the T ‐wave ampli‐ tude followed by progressive ST ‐segment ele‐ vation that occurred at the end of the first lead at 12:48:31 pm. This phenomenon directly pre‐ cedes QRS widening (which may actually repre‐ sent QRS–T wave fusion). Single ectopic beats appeared at 12:59:01 pm. From 12:59:31 pm, QRS complexes became very wide and some had single or double “hubs.” Double “hubs” of ectopy may represent the ischemic myocardi‐ um showing delay after depolarizations from multiple exit sites, which reflects a large isch‐ emic territory. From 1:01:01 pm, we observed second ‐degree atrioventricular block of increas‐ ing grade—from 2:1 to 6:1. Finally, at 1:01:01 pm, we noted the last conducted QRS complex, and then, nonconducted P waves without any escape beats. Blunt cardiac injury has been character‐ ized as a spectrum of myocardial injuries sec‐ ondary to blunt trauma.1 Few studies have described the heart rhythm at the time of death. The available reports were obtained from Holter monitoring and implanted devic‐ es: cardioverter ‐defibrillators or implantable loop recorders.2 Ventricular tachyarrhythmia remains the most frequent cause of sudden cardiac arrhythmia.3 Most arrhythmias are considered to occur within the first hour of trauma (91% within 48 hours)4; however, blunt cardiac injury may lead to fatal cardiac arrhythmias even after several days. Nonetheless, the mechanism underlying arrhythmias remains unclear. Certain patho‐ physiological changes have been discussed so far, including electrical changes between damaged A 60‐year ‐old woman underwent electrocardi‐ ography Holter monitoring in order to evaluate self ‐reported palpitations. She was treated for hypertension and had a negative family histo‐ ry of sudden cardiac death and ischemic heart disease. No other comorbidities were reported. Ethical committee approval was obtained for publishing the following case. Within 2 hours after leaving the clinic, the pa‐ tient was struck by a car on a pavement and sus‐ tained blunt cardiac injury. Her 2‐hour Holter recording documented the electrical changes in a slowly dying heart (death occurred approx‐ imately 6 minutes following the incident). There were no signs of reanimation. She had died be‐ fore the ambulance arrived. No massive blood loss or severe head injury were noted; the type of injury remains unknown. Initially (time, 12:53–12:54 pm), the recording demonstrated sinus rhythm, followed by a pair of ventricular ectopic beats (Figure 1). The injury was recorded as a distinct disturbance that oc‐ curred at 12:54 pm. Right after that, the electro‐ cardiographic trace showed a junctional rhythm with retrograde P waves evident after the 13th junctional beat, which lasted for approximate‐ ly 2 minutes. Subsequently, the escape rhythm slowed down (12:56 pm) and was accompanied by substantial pauses and ventricular ectopic beats (single ventricular premature complexes and trigeminy). We could note 2 P waves (non‐ conducted) and narrow escape QRS complexes without retrograde conduction. Surprisingly, later, at 12:57:31 pm, the trac‐ ing showed the return of what probably was sinus rhythm. During the following minutes, Correspondence to: Kamil Marcinkiewicz, MD, Department of Intensive Cardiac Therapy, The Cardinal Stefan Wyszyński institute of Cardiology, ul. Alpejska 42, 04-628 Warszawa, Poland, phone: +48 22 343 43 01, email: marcinkiewicz.kamil@gmail.com Received: December 1, 2020. Revision accepted: December 7, 2020. Published online: December 8, 2020. Kardiol Pol. 2020; 78 (12): 1301-1303 doi:10.33963/KP.15702 Copyright by the Author(s), 2020 C L I N I C A L V I G N E T T E

Death recorded by Holter monitoring due to multiple traumatic injuries as a consequence of a car accident