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PVCs and their relationship to P waves, some examples

Submitted by Dr A Röschl on Fri, 07/26/2024 - 04:37

In order to differentiate supraventricular extrasystoles/tachycardias with aberrant conduction from ventricular extrasystoles/tachycardias, the search for P waves is often very important. Here are some examples of how the P waves can be positioned around the ventricular extrasystoles.

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CRBBB and AVB and more

Submitted by Dr A Röschl on Fri, 07/26/2024 - 02:19

This is the ECG of a 50-year-old man with a congenital heart defect (we do not have exact details).
To interpret an ECG with several different abnormalities, you have to proceed systematically. You can see my comments in the second picture. Perhaps Dawn would like to add something?

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An Interesting Holter Strip

Submitted by Dr A Röschl on Wed, 01/17/2024 - 10:24

Here you can see a long rhythm strip from a Holter ECG, written at 25 mm/s. On the left, a sinus bradyarrhythmia can be seen first, followed by an atrial tachycardia. After a few beats this changes back into a sinus bradyarrhythmia. Then follows a short VT over 3 beats, after 1 sinus node beat then a ventricular couplet. Sinus bradyarrhythmia again at the end.

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Atrial Fibrillation With Rate-related Left Bundle Branch Block

Submitted by Dr A Röschl on Tue, 01/16/2024 - 03:20

For a better overview, the leads aVL and V2-V4 are not shown in this ECG. The basic rhythm is atrial fibrillation (no P waves or flutter waves visible, but fibrillation waves). When the conduction rate drops, the QRS complexes are narrow. Faster conduction results in wide QRS complexes with LBBB morphology. This is an example of phase 3 (acceleration dependant) LBBB.

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New Book From Dr. Jerry Jones

Submitted by Dawn on Mon, 01/01/2024 - 17:26

AVAILABLE NOW at:   AMAZON

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VENTRICULAR TACHYCARDIA WITH SUCCESSFUL ATP

Submitted by Dr A Röschl on Thu, 12/21/2023 - 11:15

If ventricular tachycardia occurs in an Implantable Cardioverter Defibrillator (ICD) wearer, the ICD can combat this with 2 different forms of therapy, provided these are activated (which can be done using a programming device). First, the ICD attempts to override the tachycardia. The fastest pacemaker gets control of the heart. If this is not successful, the defibrillator function is used. Here you can see the limb leads. Initially there is a relatively slow ventricular tachycardia.

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SUSTAINED VENTRICULAR TACHYCARDIA

Submitted by Dr A Röschl on Wed, 12/20/2023 - 10:11

A sustained VT is a ventricular rhythm with a frequency of more than 100 beats per minute that usually lasts at least 30 seconds or must be terminated earlier due to hemodynamic instability.
We see here a wide complex tachycardia with a frequency of approx. 105-110 beats per minute that lasts for a good minute. It begins with a premature QRS complex without a premature P wave. The short VT after the end of the sustained ventricular tachycardia with the same QRS morphology also indicates a ventricular origin of this arrhythmia.

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SICK SINUS SYNDROME

Submitted by Dr A Röschl on Wed, 12/20/2023 - 09:24

In this tracing, we see the limb leads + V1/V2. The first two beats are sinus node beats, there is a sinus bradycardia with approx. 55 bpm. Then there is a sinus arrest with a pause of 3000 ms, which is interrupted by a junctional escape beat. After this, the sinus bradycardia is re-established.

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Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB

Submitted by Dr A Röschl on Mon, 12/18/2023 - 11:14

If a wide complex tachycardia occurs, the probability is very high that it is a ventricular tachycardia (approx. 80%, in patients with a previous myocardial infarction (...) approx. 90%). Here we see a broad complex tachycardia that looks like an RBBB + LAFB, which is regular. In this constellation, 3 causes must be considered:
1. fascicular tachycardia from the left posterior fascicle of the left tawara fascicle (QRS width usually only around 130 ms, but sometimes significantly longer).
2. AT/AFL with 2:1 conduction in the case of pre-existing bifascicular block

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Ventricular Tachycardia. Unsuccessful Antitachycardia Pacing in an ICD Patient

Submitted by Dr A Röschl on Mon, 12/18/2023 - 10:48

If ventricular tachycardia occurs in an Implantable Cardioverter Defibrillator (ICD) wearer, the ICD can combat this with 2 different forms of therapy, provided these are activated (which can be done using a programming device). First, the ICD attempts to override the tachycardia. The fastest pacemaker gets control of the heart. If this is not successful, the defibrillator function is used. Here you can see the limb leads. Initially there is a relatively slow ventricular tachycardia with a heart rate of approx. 125 bpm.

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