Remove Ablation Remove Dysrhythmia Remove Ischemia
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What is the rhythm? And is there new left bundle branch block (LBBB)?

Dr. Smith's ECG Blog

Is there ischemia? ECG Diagnosis is either : 1) junctional rhythm with new LBBB, and possibly ischemia 2) accelerated idoventricular rhythm with possible ischemia, and possibly related to restoration of normal perfusion. The second explanation (AIVR), whether as a reperfusion dysrhythmia or not, seems most likely.

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A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?

Dr. Smith's ECG Blog

And superimposed subendocardial ischemia pattern, of course. Flecainide : This is a potentially dangerous Na channel blocker which can cause ventricular dysrhythmias including ventricular fibrillation. Is this patient a candidate for cardioversion or ablation? ( She was otherwise very stable during this rhythm.

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Back to basics: what is this rhythm? What are your options for treating this patient?

Dr. Smith's ECG Blog

We see a regular tachycardia with a narrow QRS complex and no evidence of OMI or subendocardial ischemia. But adenosine only lasts for seconds, and if the dysrhythmia recurs, then the adenosine is gone. Prevent the initiation of the dysrhythmia -- this can be done with a beta blocker by prenenting PACS 2. Adenosine worked.

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Young Man with a Heart Rate of 257. What is it and how to manage?

Dr. Smith's ECG Blog

The patient was found to have a "concealed" posteroseptal pathway (WPW without delta waves) confirmed to have SVT at EP study and was ablated. Here is the Electrophysilogist's note: "Only 1 pathway attachment could be ablated, the second one deep within the CS could not be ablated with high power.