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! —

Blog 159

Blog Arrhythmia Bradycardia Download 159

HeartRhythm

APRIL 30, 2024

Insertable cardiac monitors (ICMs) are used widely for long term monitoring and diagnosis of various cardiac arrhythmia. Among them, bradycardia and pause detection could be erroneous during sleep as the heart rate may slow down significantly leading to potential inappropriate diagnosis.

Bradycardia 40

Bradycardia Arrhythmia 40

HeartRhythm

MARCH 31, 2025

MODULAR ATP, a multicenter, international trial, assesses a subcutaneous ICD (S-ICD) in wireless communication to a leadless pacemaker (LP) capable of pace-terminating ventricular arrhythmias (VAs). The LP may also function as a standalone pacemaker. This analysis reports 12-month outcomes.

Bradycardia 40

Bradycardia Pacemaker Tachycardia Arrhythmia 40

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

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Chest Pain Blog Cardiac Arrest Cardiomyopathy 121

Dr. Smith's ECG Blog

JANUARY 2, 2025

Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. As described above by Dr. Smith Pacing in today's case is an effective intervention as doing so prevents the bradycardia and pauses that are likely to precipitate additional episodes of Torsades de Pointes. (

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Tachycardia Cardiomyopathy Blog Bradycardia 115

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?

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Blog Cardiac Arrest Bradycardia AFIB 137

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.

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Blog Bradycardia Arrhythmia Chest Pain 78

HeartRhythm

MARCH 31, 2025

Cardiogenic syncope can be caused by arrhythmias, such as prolonged sinus pauses, which may require permanent pacemaker implantation to alleviate symptoms of cerebral hypoperfusion due to bradycardia.

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Pacemaker Bradycardia Arrhythmia 40

HeartRhythm

MARCH 31, 2025

MODULAR ATP, a multicenter, international trial, assesses a subcutaneous ICD (S-ICD) in wireless communication to a novel leadless pacemaker (LP), delivering bradycardia pacing, ATP, or shock therapy. Upon detecting VT/VF, the S-ICD requests the LP to deliver ATP, and transitions to a sensitive detection profile (Figure, panels A&E).

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Defibrillator Bradycardia Arrhythmia Pacemaker 40

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.

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Blood Pressure Atrial Fibrillation AFIB Arrhythmia 64

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.

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Arrhythmia Bradycardia Document Tachycardia 45

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

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).

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Arrhythmia Outcomes Bradycardia Bicuspid/Mitral 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

Dr. Smith's ECG Blog

JULY 5, 2018

during which sinus bradycardia and arrhythmia are seen but not to a degree that produces symptoms. The easy way to remember the arrhythmias most commonly associated with SSS is to think of what one might expect if the SA node became sick. The indication for pacemaker placement with SSS is symptomatic bradycardia.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Bradycardia Pacemaker 52

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 ).

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Chest Pain STEMI Bradycardia Ischemia 113

MIBHS

JANUARY 31, 2025

Early detection of conditions like AFib, bradycardia, or tachycardia allows patients to address issues before they become critical. Risk Reduction Data from wearables can identify potential risks, such as undiagnosed arrhythmias or hypertension, allowing healthcare teams to address these issues before surgery.

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Heart Rhythm Technology AFIB Exercise 52

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.

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Tachycardia Dysrhythmia Bradycardia Atrial Fibrillation 114

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?

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Blog Bradycardia STEMI Download 94

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.

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Chest Pain Aneurysm Stent Stents 113

Dr. Smith's ECG Blog

JANUARY 31, 2019

== P EARL # 1: The easiest way to instantly enhance your arrhythmia interpretation skills is by using calipers. The cardiologist who does not regularly use calipers for interpretation of complex arrhythmias is a cardiologist who will miss the diagnosis on more than a few occasions. Using calipers will NOT slow you down.

Bradycardia 52

Bradycardia Pacemaker Arrhythmia Tachycardia 52

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.

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Blog Arrhythmia STEMI Bradycardia 105

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.

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Blog Arrhythmia Bradycardia Pacemaker 86

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 101

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.

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Stroke Strokes Chest Pain Cardiomyopathy 69

Ken Grauer, MD

DECEMBER 23, 2023

KEY Point: Knowing that the most commonly overlooked arrhythmia is AFlutter — suggests that the BEST way to avoid missing the diagnosis of AFlutter is simply to THINK of AFlutter whenever you have a regular SVT at a rate close to 150/minute ( in which you do not clearly see upright sinus P waves in lead II ).

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Blog Tachycardia Tricuspid Atrial Flutter 175

Circulation: Arrhythmia and Electrophysiology

NOVEMBER 10, 2023

Circulation: Arrhythmia and Electrophysiology, Ahead of Print. Serious AEs were rare; 1 patient in the etripamil arm experienced transient severe bradycardia and syncope, assessed as due to hyper-vagotonia.Conclusions:Intranasal etripamil 70 mg reduced VR and improved symptom-relief and treatment-satisfaction.

Atrial Fibrillation 40

Atrial Fibrillation Bradycardia Electrophysiology Arrhythmia 40

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

MAY 26, 2023

I focus my comments purely on a few sophisticated concepts in arrhythmia recognition — fully aware that specific rhythm disorders with calcium channel toxicity need not be treated per se, beyond providing cardiovascular support. It's always rewarding and mutually educational to discuss interesting aspects of arrhythmia interpretation.

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Cardiogenic Shock Arrhythmia Blog Education 98

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.

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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 ).

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Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 67

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.

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Technology Cardiac Arrest Innovation Coronary Artery Disease 52

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.

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Chest Pain Bradycardia Blog Critical Care 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

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.

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Exercise Cardiomyopathy Blood Pressure Physiology 40

Dr. Smith's ECG Blog

JANUARY 13, 2024

Cardiology was consulted, and the note said "no arrhythmias on telemetry or pacer interrogation." This is supported by the PT note which described a palpably irregular pulse with pauses and marked bradycardia. The final cardiology recommendation was to increase fludrocortisone and midodrine.

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Pacemaker Bicuspid/Mitral Blood Pressure Bradycardia 110

Dr. Smith's ECG Blog

JANUARY 5, 2024

The ECG shows sinus bradycardia but is otherwise normal. Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The documentation does not describe any additional details of the history. The following ECG was obtained. ECG 1 What do you think?

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Angina Plaque Document Stent 119