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ECG Challenge: Grouped Beating - Double Tachycardia

Dawn's picture
Sun, 01/25/2015 - 17:42 -- Dawn

This very interesting set of strips was donated to the ECG Guru by Arnel Carmona, well-known to many of you as the Administrator of the blog, "ECG Rhythms" and the FB page by the same name.  He is a frequent contributer to the FB page, "EKG Club", and is an ECG Guru!  This set of strips was previously posted to his blog and to the EKG Club.  In case you haven't already seen it, we will withhold the interpretation for now to give everyone a chance to comment.  In one week, we will post the interpretation.



Can Atrial Fibrillation be regular?

This strip is from a pt admitted for UTI.

This cropped lead II strip is from several hours of saved data and specifically posted in order and not necessarily in chronology to highlight a point.

1 - You can see a regular narrow complex tachycardia (NCT) at a rate of about 140’s. How will you read it? SVT? Atrial flutter? AF with RVR? ST with P waves buried in the T waves?

2 - There is still a regular NCT but there is a slowing with no discernible P waves. So AF RVR?

3- The same regular NCT but you can see  regularly-irregular QRS activity. Isn’t it that AF should be irregular and will not show any regularity?

4 - There are groups of 2 QRS with same R to R intervals. It is called GROUP BEATING.

5- There is a regular RR interval at a rate of about 70's with no discernible P waves. REGULARIZED AF?

A few interesting things the strip revealed:

1. The fastest rate was about 140's and the regularized rate was about 70's.

2. There is group beating. For beginners, it is hard to see the group beating but probably as you mature or, as you get so crazy and obsessed in looking at strips,  then you see it.  A few people would and most won't.

Most of us will think, can this be atrial flutter? This is what my other good friends in the ECG Club thought. I checked more than 72 hrs of tele-recordings and could not find the flutter waves. (BTW pt had chronic AF)

What do you think?

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