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16, 2025 Primary results from the DEFINE AFib clinical study show the Medtronic LINQ family of insertable cardiac monitors (ICM), paired with a novel algorithm, were able to detect atrial fibrillation episodes and properly risk stratify patients as high risk prior to an AF-related healthcare utilization 80% of the time. Piccini, M.D.,
Written by Pendell Meyers A man in his 70s presented with history of pacemaker presented with shortness of breath with exertion and presyncope. The ECG shows pacemaker failure with inability to capture or sense, with either underlying atrial fibrillation or junctional escape rhythm. large boxes ).
Written by Willy Frick A woman in her 90s with a history of end stage renal disease and complete heart block status post dual chamber pacemaker presented from home with acute onset dyspnea. As per Dr. Frick — pacemaker spikes are best seen in lead aVL of ECG #1. ECG is shown below. What do you think? The March 17, 2023 post — for PTA.
We admitted him for probable EP study and possible pacemaker. He underwent pacemaker placement and is doing fine. SSS is by far the most common reason for permanent pacemaker placement. New slow AFib reflects a combination of these rhythm problems. But description of a patients rhythm simply as, AFib is incomplete.
As a result, in order to differentiate MAT from the much more commonly encountered irregularly irregular rhythm ( which is AFib ) — we need to be certain we are seeing multiple different P wave morphologies that are constantly changing. MAT is not a Wandering Pacemaker. ECG Blog #200 — for an example of Wandering Atrial Pacemaker.
. = My Comment by K EN G RAUER, MD ( 3/15 /2023 ): = I found today’s case highly instructive in highlighting a number of important aspects regarding the presentation and initial treatment of a patient who presents to the ED with new AFib. I focus my comment on a few additional aspects regarding new AFib.
She had a permanent pacemaker implanted. After pacer AND conversion to sinus rhythm: Computer diagnosis: IMPRESSION ELECTRONIC VENTRICULAR PACEMAKER ABNORMAL RHYTHM ECG What is missing from this interpretation? Her K was normal 3. There was no evidence of ischemia. Thus, this is a sick AV node.
Interpreting the waves and detecting abnormalities: Typically, the heart conducts electricity in a pathway starting in the sinoatrial node (SA), our heart’s “natural pacemaker”, located in the wall of the right atrium. AFIB/AFL – atrial fibrillation or atrial flutter episodes. Usually does not exceed 160 bpm.
Electrophysiology: This specialized area focuses on heart rhythm problems, like atrial fibrillation (AFib). We offer various diagnostic and treatment options for aFib including pacemaker implantation if needed.
She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. Seeing as the patient has a single chamber ICD/pacemaker, pacing the ventricle will also lead to AV dyssynchrony that will compromise ventricular filling, further impairing hemodynamics. small squares in width (260ms).
Electrophysiology: This specialized area focuses on heart rhythm problems, like atrial fibrillation (AFib). We offer various diagnostic and treatment options for aFib including pacemaker implantation if needed.
and if not — Is the rhythm “irregularly irregular”, as in AFib — or is there a pattern of “regular" irregularity in the form of group beating ? ). This may lead to a series of symptoms similar to “pacemaker syndrome” ( ie, dizziness, fatigue, light-headedness, presyncope/syncope, dyspnea and/or chest pain ). What is the R ate?
ECG Blog #200 — for an example of Wandering Atrial Pacemaker. ECG Blog #71 — Regarding the Ashman Phenomenon with AFib. ECG Blog #65 — for an example of MAT in a patient with chronic pulmonary disease ( plus more on the differential diagnosis of MAT ). ECG Blog #289 — Review of U wave recognition ( and low K+/Mg++).
Resuscitation was initiated and this ECG was obtained: Likely AFib (irregularly irregular) with bradycardia. She was intubated and a transvenous pacemaker was inserted with good capture. Figure-3: ECG #3 — recorded after ~30 minutes in the ED, after placement of a transvenous pacemaker ( See text ). She received PR aspirin.
MAT has at least 3 distinct P-wave morphologies, but there is no single dominant pacemaker (i.e., AFib is the irregularly irregular rhythm that is most commonly confused with MAT — and , AFib is much, much, much more common than true MAT. The reasons for overlooking this arrhythmia are simple: True MAT is not a common rhythm.
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