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She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The ECG was interpreted as showing atrialflutter with 2:1 conduction. Answer : The ECG above shows a regular wide complex tachycardia. The heart rate could be compatible with that of a 2:1 conducted atrialflutter.
PEARL # 3: At this point — the most time-efficient step for solving today's rhythm will be to determine the nature of atrial activity. C ASE C onclusion : I lack detailed follow-up from today's case — other than knowing that the AtrialTachycardia was controlled. ECG Blog #138 — AFlutter vs AtrialTachycardia.
There is the appearance of STE in inferior leads II, III, and aVF (with STD in aVR), but this is entirely due to flutter waves which are only seen in those leads. Also, the atrialflutter in this case is relatively slow like in many other cases we've shown. Tachycardia and ST Elevation. AtrialFlutter with Inferior STEMI?
Then, the current flows to an area known as the bundle of His, which divides into two branches (LBB and RBB) and is the only physiological pathway connecting the atria with the ventricles. Sinus tachycardia – sinus rhythm above 100 bpm is a sinus tachycardia. AFIB/AFL – atrial fibrillation or atrialflutter episodes.
The rhythm differential for narrow, regular, and tachycardic is sinus rhythm, SVT (encompassing AVNRT, AVRT, atrial tach, etc), and atrialflutter (another supraventricular rhythm which is usually considered separately from SVTs). Therefore this patient is either in some form of SVT or atrialflutter.
The other leads that most often manifest readily identifiable 2:1 atrial activity — are leads aVR , V1 and/or V2 — so I favor first checking out these 6 leads whenever looking for AFlutter. Note that QRS morphology after conversion to sinus rhythm is very similar to QRS morphology of odd-numbered beats during the tachycardia.
Introduction:Supraventricular tachycardia (SVT) is common and poorly tolerated in patients who have undergone Fontan procedure. AtrialTachycardia (70%) and Typical AtrialFlutter (65%) were the most common SVTs ablated. Circulation, Volume 150, Issue Suppl_1 , Page A4142266-A4142266, November 12, 2024.
If the patient has Abnormal Vital Signs (fever, hypotension, tachycardia, or tachypnea, or hypoxemia), then these are the primary issue to address, as there is ongoing pathology which must be identified. Fourth, syncope in the elderly often results from polypharmacy and abnormal physiologic responses to daily events.
Conduction system pacing" is a newer technique that is being studied as a way of delivering more physiologic pacing, typically by inserting a lead into the area of the left bundle branch, or the bundle of His. Additionally, the patient had no other apparent reason to have sinus tachycardia (such as volume depletion, bleeding, fever).
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