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Jason's Blog: ECG Challenge of the Bi-Week for Nov. 18th - Dec. 1st.

jer5150's picture

Patient's clinical data:  64-year-old white man.

What is the rhythm seen in this 12-lead ECG?

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Submitted by marionurse on

Sinus prolong QT, St segments flate. Fussion beats retrograde P wave runs VT X3, coming from R side of heart. Compesentory pause might be prolong, poss. sinus Brady?

Submitted by marionurse on

Sinus prolong QT, St segments flate. Fussion beats retrograde P wave runs VT X3, coming from R side of heart. Compesentory pause might be prolong, poss. sinus Brady?

Interesting strip! Probably sinus bradycardia (mitrale P-waves in II) based on the pause duration, long QTc, diffuse ST-depression, triplet PVC's with retrograde capture of the atria. The PVC's are notable for an rS complex in V1 and a slightly shorter RP than the PR, so perhaps these are occuring close to or near the conduction tissue by the AVN.

Christopher
sixlettervariable.blogspot.com
ems12lead.com

Submitted by zafer on
  • SINUS RHYTHM
  • NON-SUSTAINED V-TACH
  • AVD
  • LAA
  • ST-T ABNORMALITIES IN SINUS COMPLEXES

zafer karabulut

Submitted by dr_rshama on

SR, SB, the baseline ECG does not show pathology except for the abnormal P wave. NSVT [3 beats] with retrograde P wave. The QRS complex of the NSVT is narrowish and looks originating close to the conduction system in the postero-septal area close to the left posterior fascicle. This is definitely automatic focus and not reentrant one!!

ekgpress@mac.com's picture

Knowing Jason (at least knowing him thru his ECG expertise) - I suspect he has at least one follow-up tracing on this patient that he is planning to show us ... What I see here is underlying sinus rhythm (sinus brady) - with salvos. Each ventricular beat manifests retrograde conduction with a fixed RP. The coupling interval for the 1st PVC in each grouping is constant. Of interest - the rate for the salvo is not overly fast (~120/min) - and the R-R interval within each salvo is not precisely the same - but the pattern IS the same from one salvo to the next. So reading much more into this than I normally would (since it is a "Jason tracing" ) - I wonder about some type of exit block ...

Ken Grauer, MD  www.kg-ekgpress.com   [email protected] 

jer5150's picture
Submitted by jer5150 on

INTERPRETATION:

1.  Sinus rhythm (? sinus bradycardia; rate indeterminate) interrrupted by . . . 
2.  . . . short, 3-beat trios of ventricular tachycardia with 1:1 retrograde atrial activation (arrows) 
3.  Intraatrial block

COMMENTS:
The computer calculated the duration of the QT interval at 390 ms and the QTc at 474 ms.  There are nonspecific ST-T abnormalities.  The R-P' interval on the VPBs is comparable to the conducted P-R interval on the sinus beats.  When compared to other causes of "group beating", this is a relatively rare form. 

It would serve no practical purpose to call this ventricular quadrigeminy.  "When consecutive VPBs follow each sinus beat, we already have a better name for it since, by definition, three consecutive VPBs make the shortest definable run of tachycardia" (1)

Reference/Source:
(1)  Marriott HJL. Practical Electrocardiography. 8th ed. Baltimore: William & Wilkins, 1988, p. 142

Jason E. Roediger - Certified Cardiographic Technician (CCT)
[email protected]

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