ECG Guru - Instructor Resources - Long QT interval https://www.ecgguru.com/ecg/long-qt-interval en Bigeminal Rhythm With Aberrant Conduction https://www.ecgguru.com/ecg/bigeminal-rhythm-aberrant-conduction <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/bigeminal-rhythm-aberrant-conduction"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/NSR%20PACs%20Aberr.jpg" width="1800" height="1341" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG is a good example of sinus rhythm with aberrantly-conducted PACs.&nbsp; The tracing was donated to the ECG Guru several years ago by Dr. Ahmed from Sanjiban Hospital in India.&nbsp; We have no patient data for this tracing.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal">The underlying rhythm here is normal sinus rhythm. Most of the parameters – rate, PR interval, and QRS duration – are normal.&nbsp; The QTc interval, which is the QT interval corrected to a rate of 60 bpm, is prolonged at 568 ms.&nbsp; We do not know the patient’s clinical condition or medications, so we cannot guess at the reason.&nbsp; However, a prolonged QTc is associated with an increased risk of <span style="color: red;"><a href="http://lifeinthefastlane.com/ecg-library/tdp/">Torsades de pointes,</a></span> a type of polymorphic ventricular tachycardia.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal">The first three beats appear the same (Leads I, II, and III).&nbsp; However, the first R-to-R interval is shorter than the second one.&nbsp; This could be due to rate variation, a concealed sinus block, or a premature atrial contraction (PAC). &nbsp;&nbsp;The P wave of the “early” beat, marked #1, looks slightly different from the other P waves in Lead II, but, because of the slow rate, there is no way to be sure without a longer rhythm strip.&nbsp; After the possible PAC, the rhythm becomes coupled, probably <span style="color: red;"><a href="http://ecgguru.com/ecg/sinus-rhythm-atrial-bigeminy">atrial bigeminy,</a> </span>where every other beat is a PAC.&nbsp; There are several mechanisms that cause grouped beating, but atrial ectopic bigeminy is the most common. Normally, PACs have different-looking P waves compared to the sinus beats. &nbsp;In this ECG, the P waves are often buried in the preceding T waves, and are hard to evaluate.<span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">Interestingly, the PACs in this strip are conducted with varying amounts of <span style="color: #c00000;"><a href="http://www.metealpaslan.com/ecg/aberasyonen.htm">aberrancy</a>.&nbsp; </span>Because they are premature, they find the ventricles in varying stages of repolarization.&nbsp; When the ventricles are not completely repolarized, the electrical impulse may conduct down the more recovered conduction pathways, while going around the less recovered pathways.&nbsp; A common form of aberrant conduction is <span style="color: #c00000;"><a href="http://ecgguru.com/ecg/instructors-collection-ecg-week-september-23-2015-right-bundle-branch-block-0">right bundle branch block</a></span>.&nbsp; In RBBB aberrant conduction, the impulse finds the right bundle branch temporarily unable to conduct, so it follows the left bundle branch down into the ventricles.&nbsp; The left ventricle is depolarlized slightly ahead of the right, and the common ECG pattern of a wide QRS with rSR’ pattern in V1 and Rs in Leads I and V6 will appear.</span><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The PAC marked “2” probably has a small degree of aberrancy.&nbsp; The PACs marked “3” and “4” appear almost like the normal beats.&nbsp; PACs “5” and “6” have clearly taken on the form of right bundle branch block, including the T wave changes commonly seen with RBBB.</span><span style="font-size: 8pt; line-height: 107%;">&nbsp;</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><span style="font-size: 10.0pt; line-height: 107%;">The clinical significance of the grouped beating, and of the prolonged QT interval, would have to be evaluated before treatment is decided.&nbsp; But, this ECG provides students with a good opportunity to see variations on aberrant conduction.</span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/640/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Bigeminal Rhythm With Aberrant Conduction 1/5</option><option value="40">Give Bigeminal Rhythm With Aberrant Conduction 2/5</option><option value="60">Give Bigeminal Rhythm With Aberrant Conduction 3/5</option><option value="80" selected="selected">Give Bigeminal Rhythm With Aberrant Conduction 4/5</option><option value="100">Give Bigeminal Rhythm With Aberrant Conduction 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.5</span></span> <span class="total-votes">(<span >8</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-i4Tmjbn7t3LURNL6htHXKcMY_3hPGGg_RA2QxN1qwYk" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/right-bundle-branch-block-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Right bundle branch block</a></div><div class="field-item odd"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item even"><a href="/ecg/long-qt-interval" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Long QT interval</a></div><div class="field-item odd"><a href="/ecg/pac" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">PAC</a></div><div class="field-item even"><a href="/ecg/atrial-bigeminy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial bigeminy</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fbigeminal-rhythm-aberrant-conduction&amp;title=Bigeminal%20Rhythm%20With%20Aberrant%20Conduction"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Thu, 25 Feb 2016 02:09:38 +0000 Dawn 688 at https://www.ecgguru.com https://www.ecgguru.com/ecg/bigeminal-rhythm-aberrant-conduction#comments