Journal of Cardiovascular Electrophysiology

DECEMBER 7, 2023

Abstract Background Programed ventricular stimulation (PVS) is a risk stratification tool in patients at risk for adverse arrhythmia outcomes. Patients with negative PVS may yet be at risk for adverse arrhythmia-related events, particularly in the presence of symptomatic ventricular arrhythmias (VA).

Arrhythmia 40

Arrhythmia Outcomes Bradycardia Bicuspid/Mitral 40

Ken Grauer, MD

NOVEMBER 30, 2024

To Emphasize: Regardless of whether the rhythm in Figure-1 represents 2nd- or 3rd-degree AV block — the overall ventricular rate is slow ( in the 40s/minute ) — so that IF this patient is symptomatic and no “fixable” cause of the bradycardia is found — pacing might still be needed. The "Longer" Answer: = What then is going on?

Blog 127

Blog Arrhythmia Bradycardia Pacemaker 127

Heart BMJ

JUNE 17, 2024

Learning objectives To review the potential arrhythmia complications during pregnancy and puerperium in women with and without known cardiovascular disease. To recognise arrhythmia conditions associated with a high risk of pregnancy-related cardiac complications for which intervention before considering pregnancy is appropriate.

Arrhythmia 45

Arrhythmia Bradycardia Document Tachycardia 45

Open Heart

JULY 28, 2023

Introduction The incidence of arrhythmia in heart failure with non-reduced ejection fraction (HFnon-rEF) in patients who have a history of hospitalisation is unclear. Methods and analysis This is a multicentre single arm study to evaluate the usefulness of ILR for detecting arrhythmia.

Atrial Fibrillation 40

Atrial Fibrillation Arrhythmia Heart Failure Tachycardia 40

HeartRhythm

FEBRUARY 27, 2024

Bradyarrhythmias including sinus bradycardia and atrioventricular (AV) block are frequently encountered in endurance athletes especially at night.

Bradycardia 40

Bradycardia Electrophysiology Pacemaker Arrhythmia 40

Open Heart

NOVEMBER 11, 2024

Overall, a mixed cardioneuro phenotype was demonstrated including autonomic (75%), small (58%) and large fibre (46%) neuropathy largely predating a cardiac phenotype consisting of heart failure (63%), atrial arrhythmia (42%) and bradycardia (13%).

Heart Failure 52

Heart Failure Bradycardia Laboratory Cardiomyopathy 52

HeartRhythm

APRIL 30, 2024

It is recognized that LQTS in the fetus may present as sinus bradycardia (SB), functional 2:1 atrioventricular block and ventricular arrhythmias (VA). Due to variable phenotypic expression a prolonged QT interval on a 12-lead ECG is not always present.

Sudden Cardiac Death 40

Sudden Cardiac Death Bradycardia Arrhythmia 40

Dr. Smith's ECG Blog

JULY 21, 2024

However, he suddenly developed a series of malignant ventricular arrhythmias. Below are printouts of some of the arrhythmias recorded. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. The arrhythmia starts with a PVC having a short coupling interval.

Arrhythmia 116

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 116

Ken Grauer, MD

OCTOBER 13, 2023

With P waves labeled — Isn't it now much easier to appreciate that the atrial rhythm is quite regular ( with no more than a slight sinus arrhythmia )? P utting I t A ll T ogether : The precise mechanism of today's arrhythmia is complex and difficult to determine. For those with a special interest in cardiac arrhythmias — READ ON! —

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Blog Arrhythmia Bradycardia Download 160

Frontiers in Cardiovascular Medicine

DECEMBER 19, 2023

Background The rising adoption of wearable technology increases the potential to identify arrhythmias. Those with arrhythmias or non-diagnostic EKGs were sent 7-day monitors. The EHR was reviewed after 3 years to determine if participants developed arrhythmias. Mean age was 50.5 (SD years, and 46 (53.3%) were female.

Blood Pressure 64

Blood Pressure Atrial Fibrillation AFIB Arrhythmia 64

Ken Grauer, MD

JUNE 2, 2023

to 1828 msec. ) — which corresponds to a variation in the rate of sinus bradycardia from 36-to-33/minute. This makes sense given that the underlying rhythm in today's case appears to be marked sinus bradycardia and arrhythmia , with a ventricular escape rhythm appearing when the SA node rate drops below 33/minute.

Blog 78

Blog Bradycardia Arrhythmia Tachycardia 78

Dr. Smith's ECG Blog

JUNE 5, 2024

IMPRESSION: The finding of sinus bradycardia with 1st-degree AV block + marked sinus arrhythmia + the change in PR interval from beat #5-to-beat #6 — suggests a form of vagotonic block ( See My Comment in the October 9, 2020 post in Dr. Smith's ECG Blog ). Initial high sensitivity troponin I returned at 6ng/L (normal 0.20

Chest Pain 109

Chest Pain Blog Cardiac Arrest Cardiomyopathy 109

Heart BMJ

DECEMBER 15, 2023

Reflex syncope is defined as a transient loss of consciousness due to a neurally mediated reflex causing sudden-onset vasodilation and bradycardia, leading to a steep decrease in blood pressure and cerebral hypoperfusion. Thus, once the aetiology is established, further diagnostic tests are seldom performed.

Blood Pressure 40

Blood Pressure Bradycardia Pacemaker Arrhythmia 40

Dr. S. Venkatesan MD

NOVEMBER 22, 2024

We don’t need to think deep, to realize, modalities which take on this arrhythmia head-on has a minuscule role at the population level. Any good physician can easily recognize and manage this arrhythmia with simple measures, advices and liberal use of beta blockers, without the need of tricky drugs like Amiodarone.

Atrial Fibrillation 52

Atrial Fibrillation Arrhythmia Risk Factors Bradycardia 52

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

Altered Mental Status, Bradycardia == MY Comment , by K EN G RAUER, MD ( 2/2 /2024 ): == Dr. Meyers began today’s case with the clinical challenge of asking you to identify the underlying cause of ECG #2. -- Read this ECG -- Osborn Waves and Hypothermia (this is the "Figure" above) What does LBBB look like in severe hypothermia?

Blog 134

Blog Cardiac Arrest Atrial Fibrillation Bradycardia 134

All About Cardiovascular System and Disorders

MARCH 17, 2024

It can automatically detect life threatening ventricular arrhythmias and treat them, either with a shock or, sometimes by overdrive pacing. And, after the shock, if there is bradycardia, it can be covered by these two pacing electrodes, one at the tip, and one proximal to it. These are high voltage, defibrillator shock coils.

Myocardial Infarction 52

Myocardial Infarction Defibrillator Sudden Cardiac Death Arrhythmia 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2024

Finally — Regardless of whether the 2:1 AV block is seen — there is marked bradycardia ( rate in the 40s ) , which of itself deserves investigation prior to approval for elective surgery. What follows is a "deep dive" into some of the intricacies of the 2nd-degree AV block for readers with an interest in advanced arrhythmia interpretation.

Arrhythmia 71

Arrhythmia Bradycardia Outpatient Pacemaker 71

Dr. Smith's ECG Blog

JUNE 27, 2024

EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. Limiting one's interpretation to marked bradycardia with high-grade AV block in need of pacing in this patient with multiple syncopal epiosodes — more than suffices for "the quick answer". Figure-3: I've labeled ECG #3.

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Blog Pacemaker Bradycardia Tachycardia 119

Ken Grauer, MD

JANUARY 20, 2024

Looking first at the long-lead II rhythm strip — there is significant bradycardia , with a heart R ate just under 40/minute. But the point to emphasize — is that it should only take seconds to recognize that there is bradycardia from significant AV block. = Would you approve her for a nonemergent surgical procedure?

Blog 95

Blog Bradycardia STEMI Download 95

Dr. Smith's ECG Blog

MARCH 22, 2024

I will leave more detailed rhythm discussion to the illustrious Dr. Ken Grauer below, but this use of calipers shows that the rhythm interpretation is: Sinus bradycardia with a competing (most likely junctional) rhythm. preceding each of the fascicular beats — indicating a faster rate for the escape rhythm compared to the sinus bradycardia ).

Chest Pain 112

Chest Pain STEMI Bradycardia Ischemia 112

Dr. Smith's ECG Blog

AUGUST 9, 2024

There are three mechanisms of arrhythmia: automatic, re-entry, and triggered. The most common triggered arrhythmia is Torsades de Pointes. It is a benign arrhythmia which requires no specific treatment. Possible mechanisms of ventricular arrhythmias elicited by ischemia followed by reperfusion. Do not treat AIVR.

Chest Pain 87

Chest Pain Arrhythmia Myocardial Infarction STEMI 87

All About Cardiovascular System and Disorders

APRIL 17, 2024

Ventricular tachycardia is a potentially life threatening cardiac arrhythmia. Polymorphic VT is managed by intravenous magnesium and measures to increase heart rate like pacing as it occurs most often in the setting of bradycardia and QT interval prolongation. If the rate is very fast, hemodynamic deterioration can occur rapidly.

Tachycardia 52

Tachycardia Defibrillator Congenital Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Other cardiac-related causes for syncope associated with acute MI may include malignant ventricular arrhythmias and bradyarrhythmias including AV block. The "good news" — is that a cardiac-related cause of syncope is unlikely if the initial ECG is normal, and cardiac monitoring in the ED fails to reveal significant arrhythmia.

Chest Pain 108

Chest Pain Aneurysm Stent Stents 108

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ). NOTE: Prediction of cardiac contusion "severity" on the basis of cardiac arrhythmias and ECG findings — is an imperfect science. RBBB in blunt chest trauma seems to be indicative of several RV injury. QTc prolongation.

Tachycardia 109

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 109

Ken Grauer, MD

JULY 18, 2024

Most of the time with AV block — the atrial rhythm will be regular ( or at least almost regular — if there is an underlying sinus arrhythmia ). PEARL # 5: As noted above — today's arrhythmia appears to represent some form of 2nd-degree AV block. Figure-4: I needed to draw a laddergram.

Blog 87

Blog Arrhythmia Bradycardia Pacemaker 87

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

I added, "Makes me wonder if this could be myocarditis in a younger adult — maybe even with sinus arrhythmia." That said, despite the group beating — the rhythm is not consistent with AV Wenckebach. Figure-1: The initial ECG in today's case.

Stroke 70

Stroke Strokes Chest Pain Cardiomyopathy 70

Ken Grauer, MD

FEBRUARY 9, 2024

Whatever the specific etiology of today's arrhythmia is, the “good news” is — that this rhythm will most probably improve with reperfusion of the "culprit" artery. That said — I found today's arrhythmia fascinating, and worthy of more in-depth analysis. Using calipers facilitates the process.

Blog 106

Blog Arrhythmia STEMI Bradycardia 106

All About Cardiovascular System and Disorders

MAY 2, 2024

Athlete’s bradycardia due to increased parasympathetic tone and decreased sympathetic tone is a well-known observation. Though sinus bradycardia is usual, other abnormalities like sinus arrhythmia, sinus arrest, wandering atrial pacemaker and coronary sinus rhythm have been described.

Exercise 40

Exercise Cardiomyopathy Blood Pressure Physiology 40

Dr. Smith's ECG Blog

MARCH 15, 2023

Baseline bradycardia in endurance athletes limits the use of ß-blockers. The Role of Sinus Arrhythmia: I found it interesting to compare the long lead II rhythm strips in the 3 serial tracings from today’s case ( Figure-1 ). Note fairly marked irregularity of the R-R interval — indicative of definite sinus arrhythmia.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

Learning points : Takotsubo can lead to cardiac arrest from ventricular arrhythmia. Most Torsades is the result of a pause-dependent effect that predisposes to development of the malignant arrhythmia ( Dohadwala et al — Heart Rhythm Case Rep 3(2):115-119, 2017 ).

Cardiac Arrest 67

Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 67

Dr. Smith's ECG Blog

JANUARY 21, 2023

This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern. ECG met STEMI criteria and was labeled STEMI by computer interpretation.

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52

Ken Grauer, MD

OCTOBER 27, 2023

That said — obvious findings include: i ) Marked bradycardia! — L addergram I llustration : At this point — I needed to work out, and then draw a laddergram that I could then verify to ensure a plausible mechanism for today's arrhythmia. The rhythm in Figure-1 is complex — and defies precise interpretation without careful study.

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Blog Pacemaker Bradycardia Arrhythmia 103

Wellnest

JUNE 19, 2023

Similarly, you may use our , app to adjust the paper speed along with amplification to read the slightest changes, especially for conditions like tachycardia and bradycardia. Alternatively, it also helps enhance arrhythmia management with coronary artery disease. It improves the prediction model for myocardial scar mass.

Technology 52

Technology Cardiac Arrest Innovation Coronary Artery Disease 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

He has a family history concerning for arrhythmia. Given the circumstances of his car crash, we presume it was due to an underlying arrhythmia. He has a family history concerning for arrhythmia with his father requiring some sort of device (PPM, ICD, unclear) at a young age.

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

Sci 5[4] 268-270, 2015 ) both highlight a likely association between acute development of ischemic J waves — and high risk of developing malignant ventricular arrhythmias.

Cardiac Arrest 52

Cardiac Arrest Bradycardia Chest Pain Ischemia 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

VT is the second most common presenting arrhythmia. Vaso or inotropic medications are not harmless, and can precipitate life threatening arrhythmias. It is common with 2nd- and 3rd-degree AV block to see a " ventriculophasic " sinus arrhythmia. AV block is the first manifestation of CS in more than 30% of patients.

Tachycardia 87

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 87

Dr. Smith's ECG Blog

JULY 16, 2022

The computer called "Sinus Bradycardia" only (implying that everything else is normal. The overreading Cardiologist called it only "Sinus Bradycardia" with no other findings. The rhythm in Figure-1 is sinus bradycardia and arrhythmia. These features are subtle — but they are definitely present and important to recognize.

Chest Pain 52

Chest Pain Bradycardia Blog Critical Care 52