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ECG Basics: Sinus Rhythm With Non-Conducted PACs

This is a good strip to demonstrate the change in the appearance of a T wave when a premature P wave occurs on the preceding T wave.  The PACs found the atria ready to depolarize and produced a P wave that landed on top of the preceding T wave, making it appear taller than the others.  The PACs also reset the sinus node, causing a slight delay before the next sinus discharge.  The PACs occurred while the ventricles were still refractory, so no QRS complexes followed.

Dawn's picture

Sinus Rhythm With Non-Conducted Atrial Bigeminy

Jason's Blog: ECG Challenge of the Week, 6-8-12     INTERPRETATION:

 

1)  In first half of strip: Normal sinus rhythm (rate = 100/min) with . . .

2)  . . . bifascicular block—right bundle-branch block plus left anterior hemiblock 

      (RBBB + LAHB), left axis deviation (LAD) at -57 degrees.

3)   In second half of strip: Sinus rhythm interrupted by a run of nonconducted atrial bigeminy  (arrows (↓); see laddergram).

 

Jason E. Roediger, CCT, CRAT

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