Remove Atrial Fibrillation Remove Pacemaker Remove Tachycardia
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Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia

Dr. Smith's ECG Blog

So it must be atrial fibrillation. Then I always look to see if the initial deflection of the QRS has a lot of voltage change per change in time (seen in tachycardias that are initiated from above the ventricle because the propagate through fast conducting purkinje fiber. Pacemaker mediated tachycardia!

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A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. Answer : The ECG above shows a regular wide complex tachycardia. The last echocardiography 12 months ago showed HFmrEF.

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Regular Wide Complex Tachycardia. What to do?

Dr. Smith's ECG Blog

A patient in the ICU with significant underlying cardiac disease [HFrEF 30%, non-ischemic cardiomyopathy, LBBB s/p CRT-D (biventricular pacer), AVNRT s/p ablation a few yrs ago, hx sinus tachycardia while on max tolerated BB therapy] went into a regular wide-complex tachycardia after intubation for severe COPD exacerbation. What to do?

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Atrial fibrillation? Multifocal Atrial Tachycardia? Don't look at computer read until AFTER you interpret!

Dr. Smith's ECG Blog

Here is the computer interpretation: ATRIAL FIBRILLATION WITH RAPID VENTRICULAR RESPONSE WITH ABERRANT CONDUCTION OR VENTRICULAR PREMATURE COMPLEXES LEFT AXIS DEVIATION [QRS AXIS beyone -30] NONSPECIFIC ST and T-WAVE ABNORMALITY The over-reading physician confirmed this diagnosis, which is incorrect. It is not atrial fibrillation.

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A multicenter analysis of implantable monitoring device-based diagnosis of supraventricular arrhythmia post patent foramen ovale closure: the OCCL-ILR study

Frontiers in Cardiovascular Medicine

Primary endpoint was the incidence of patients with new onset supraventricular arrhythmia (AF, atrial flutter or any supraventricular tachycardia) lasting >30s, post PFO closure.ResultsA total of 59 patients met the inclusion criteria.

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PO-05-064 A UNIQUE CASE OF REPETITIVE NON-REENTRANT VENTRICULOATRIAL SYNCHRONY INDUCING RECURRENT ATRIAL FIBRILLATION

HeartRhythm

Repetitive Non-reentrant Ventriculoatrial Synchrony (RNRVAS) is a rare phenomenon seen in dual chamber pacemakers with atrial tracking.

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Syncope and Atrial fibrillation in a Healthy 70-something Male

Dr. Smith's ECG Blog

PMH: Known paroxysmal Atrial fib. He is usually is in sinus rhythm as far as he knows, but he cannot subjectively feel atrial fibrillation, so he is never completely certain when he is in sinus or atrial fib. Here is his ECG: Atrial Fib with a Ventricular Response of about 66. He immediately completely recovered.