Dr. Smith's ECG Blog

MARCH 28, 2024

male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Description : Regular Wide Complex Tachycardia at a rate of about 160. SVT with aberrancy?

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Tachycardia Atrial Fibrillation AFIB Atrial Flutter 129

DAIC

JUNE 19, 2024

Cingolani, director of Cardiogenetics and Preclinical Research in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, is exploring new ways to help patients with ventricular tachycardia (VT), a recurring, abnormally fast and irregular heartbeat that starts in the lower chambers, or ventricles, of the heart.

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Tachycardia Cardiac Arrest Ablation Research 128

Dr. Smith's ECG Blog

JUNE 28, 2023

A prehospital 12-lead was recorded: There is a regular wide complex tachycardia. The computer diagnosed this as Ventricular Tachycardia. There is a wide complex regular tachycardia at a rate of 226. Toothache, incidental Wide Complex Tachycardia Could it be fascicular VT or Bundle Branch VT ( i.e., idiopathic VT )?

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Tachycardia Ultrasound Heart Disease Atrial Fibrillation 97

Ken Grauer, MD

NOVEMBER 10, 2023

== — CLICK HERE — for a V ideo presentation of this case! Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #220 — == The long lead II rhythm strip shown in Figure-1 was obtained from an 51-year-old man who presented to the ED ( Emergency Department ) with "palpitations" that began 1 hour earlier.

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Blog Tachycardia Arrhythmia 193

Dr. Smith's ECG Blog

JULY 17, 2023

There is a regular narrow complex tachycardia. Thus, it is supraventricular tachycardia. It is important to remember that SVT includes Sinus Tachycardia! Sometimes even Wide Complex Tachycardia is Sinus. See this case in which Lewis leads were necessary to figure this out: Wide Complex Tachycardia.

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Tachycardia Atrial Flutter Blog Exercise 93

ECG Guru

MAY 24, 2024

ECG Number 1, 11:57 a.m.: There is a wide-complex tachycardia at a rate of about 230 bpm. We do not have information about her past medical history. We will update this post if we receive information about her outcome. The QRS is.15 15 seconds (150 ms). The QRS frontal plane axis is leftward.

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Tachycardia Outcomes 98

Dr. Smith's ECG Blog

JUNE 21, 2024

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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Tachycardia Atrial Fibrillation Pacemaker Blog 75

Medical Xpress - Cardiology

OCTOBER 8, 2024

A multicenter study has described and validated a new strategy for guiding ablation procedures in patients with complex tachycardias. This type of procedure is frequently used to treat ventricular tachycardias originating in areas affected by scarring after a myocardial infarction.

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Tachycardia Myocardial Infarction Heart Rhythm Ablation 81

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

I find AV dissociation in VT to be very difficult to differentiate from artifact, as there are always random blips on tachycardia tracings. Read this post: Idiopathic Ventricular Tachycardias for the EM Physician 2. The 15th beat (2nd beat of V1-V3) appears to be a fusion beat , which is all but diagnostic of VT.

Tachycardia 141

Tachycardia Cardiogenic Shock Angina Coronary Angiogram 141

Medical Xpress - Cardiology

JANUARY 10, 2024

Patients with post-COVID-19 vaccination postural orthostatic tachycardia syndrome (POTS) all have preexisting conditions, according to a study published in the January issue of Heart Rhythm.

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COVID-19 Tachycardia POTS Heart Rhythm 86

Dr. Smith's ECG Blog

JANUARY 9, 2024

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. Said differently, the ECG shows a rather slow ventricular tachycardia with a 2:1 VA conduction. Cardiac output (CO) was being maintained by the tachycardia.

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Tachycardia Electrophysiology Atrial Flutter Ischemia 107

HeartRhythm

JANUARY 25, 2024

Differentiating between atypical atrioventricular node re-entrant tachycardia (aAVNRT) and orthodromic reciprocating tachycardia (ORT) utilizing a septal accessory pathway is a complex challenge.

Tachycardia 75

Tachycardia 75

American College of Cardiology

NOVEMBER 16, 2024

The goal of the VANISH2 trial was to compare endocardial catheter ablation with conventional antiarrhythmic drug (AAD) therapy as a first-line treatment for infarct-related ventricular tachycardia (VT) in ischemic cardiomyopathy.

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Tachycardia Ablation Heart Disease Cardiomyopathy 68

All About Cardiovascular System and Disorders

APRIL 17, 2024

Ventricular tachycardia is a potentially life threatening cardiac arrhythmia. On the ECG, ventricular tachycardia can be defined as three or more ventricular ectopic beats occurring in a sequence at a rate more than 100 per minute. Another rare form of ventricular tachycardia is bidirectional ventricular tachycardia.

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Tachycardia Defibrillator Congenital Ischemia 52

Dr. Smith's ECG Blog

JUNE 11, 2023

The ECGs show a wide complex, irregularly irregular tachycardia. At that time, he presented via EMS and had received magnesium and lidocaine prehospital for concerns of ventricular tachycardia. On arrival to the ED, he was noted to be in a wide complex tachycardia with a rate in the 240s.

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Tachycardia Atrial Fibrillation Chest Pain Blood Pressure 91

Ken Grauer, MD

OCTOBER 10, 2024

QUESTIONS: Is this rhythm too fast to be sinus tachycardia? However, until such time that we know for certain — I think it best to simply describe what we see: PEARL # 1: Realize that for any tachycardia — there are 6 Parameters that need to be assessed. Are flutter waves hidden within the QRS and T waves? s in Figure-2 ).

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Blog Tachycardia Atrial Flutter 170

Dr. Smith's ECG Blog

DECEMBER 20, 2024

Additionally, the patient had no other apparent reason to have sinus tachycardia (such as volume depletion, bleeding, fever). So the most likely rhythm in ECG 1 is ectopic atrial tachycardia. Therefore the first part of ECG 1 shows ectopic atrial tachycardia with biventricular pacing. Point 1: What is PVARP?

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Chest Pain Tachycardia Pacemaker Defibrillator 57

Ken Grauer, MD

DECEMBER 12, 2024

I was sent the ECG in Figure-1 initially told only that it was obtained from an older man with palpitations. The cardiology team thought the rhythm was an SVT ( S upra V entricular T achycardia ) with QRS widening as a result of aberrant conduction.

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Blog Tachycardia Heart Disease Congenital Heart Disease 82

Dr. Smith's ECG Blog

FEBRUARY 16, 2024

But it is not disorganized enough to be polymorphic ventricular tachycardia. Learning Points: Wide complex irregularly irregular tachycardias include PMVT, AF with WPW, and AF with aberrancy. See our other cases of AF with WPW: A young man with another episode of tachycardia. What do you want to do? Smith : I always cardiovert.

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Tachycardia Atrial Fibrillation Chest Pain Blood Pressure 134

Heart BMJ

JULY 10, 2024

Clinical introduction A woman in her 60s with non-obstructive coronary artery disease, aortic valve replacement and aortic arch repair, chronic diastolic heart failure and paroxysmal atrial fibrillation (AF) and flutter (AFL), presented with 3 days of sustained palpitations that felt similar to prior episodes of AF/AFL.

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Tachycardia Aortic valve Coronary Artery Disease Atrial Fibrillation 102

Journal of Cardiovascular Electrophysiology

SEPTEMBER 16, 2024

Abstract Introduction Understanding the spatiotemporal location of the spontaneous termination of ventricular tachycardia (VT) may provide new insights for ablation.

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Tachycardia Ablation Electrophysiology Article 75

ECG Guru

DECEMBER 18, 2023

If a wide complex tachycardia occurs, the probability is very high that it is a ventricular tachycardia (approx. Here we see a broad complex tachycardia that looks like an RBBB + LAFB, which is regular. 80%, in patients with a previous myocardial infarction (.) In this constellation, 3 causes must be considered: 1.

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Myocardial Infarction Tachycardia 124

Frontiers in Cardiovascular Medicine

JANUARY 10, 2024

However, widely split P' waves in focal atrial tachycardia (AT) on a surface electrocardiogram (ECG) have rarely been reported. An electrophysiological study showed that the tachycardia arose from the left atrial appendage (LAA) and was conducted through two distinct pathways.

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Tachycardia Electrophysiology Atrial Fibrillation Electrocardiogram 59

Dr. Smith's ECG Blog

JANUARY 23, 2024

Shortly after isoprenalin infusion was initiated, there were short runs of ventricular tachycardia. During the next 24 hours, she experienced periods of complete AV block with a ventricular escape rhythm in the 20s. She was started on isoprenalin (isoproterenol). The following ECG was recorded during one of these episodes of VT.

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Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 92

Nature Reviews - Cardiology

JANUARY 1, 2024

In this Review, Fedorowski and colleagues define the major forms of CVAD (including postural orthostatic tachycardia syndrome), and discuss the aetiology, diagnosis and management of post-COVID-19 syndrome-associated CVAD.

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COVID-19 Tachycardia 145

Ken Grauer, MD

MARCH 23, 2023

C ASE C onclusion : I lack detailed follow-up from today's case — other than knowing that the Atrial Tachycardia was controlled. This type of Wenckebach response that may be seen with atrial tachycardia ( or atrial flutter ) — is often physiologic, as a result of the rapid atrial rate that occurs with these arrhythmias.

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Blog Tachycardia Arrhythmia Atrial Flutter 78

Medical Xpress - Cardiology

DECEMBER 19, 2023

Heart rates are easier to monitor today than ever before. Thanks to smartwatches that can sense a pulse, all it takes is a quick flip of the wrist to check your heart. But monitoring the cells responsible for heart rate is much more challenging—and it's encouraged researchers to invent new ways to analyze them.

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Research Tachycardia 103

Dr. Smith's ECG Blog

OCTOBER 21, 2023

On the monitor patient had wide-complex tachycardia. Differential is ventricular tachycardia versus supraventricular tachycardia with aberrancy versus sinus tachycardia with a aberrancy. After the patient was stabilized with supportive care, the heart rate gradually slowed, confirming sinus tachycardia.

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Tachycardia Pulmonary Blood Pressure Blog 141

Ken Grauer, MD

JUNE 22, 2024

The ECG in Figure-1 — was obtained from a middle-aged woman with positional tachycardia and diaphoresis with change of position from suprine to sitting. My THOUGHTS on the ECG in Figure-1: The rhythm is sinus tachycardia at ~105/minute ( ie, The R-R interval is regular — and just under 3 large boxes in duration ).

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Blog Ischemia Tachycardia Cardiomyopathy 173

ECG Guru

JULY 30, 2024

The next PAC is conducted via the slow pathway, then the AV nodal reentry tachycardia (slow/fast) starts. The first 3 beats are sinus node beats, all have the same morphology of the P wave. This is followed by a PAC, which is conducted via the fast pathway in the AV node.

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Tachycardia 52

Dr. Smith's ECG Blog

JUNE 2, 2023

She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for a regular tachycardia, possible rales at both bases, some mild RUQ abdominal tenderness. Thus, I believe it is a regular, monomorphic, wide complex tachycardia. Or it could simply still be classic VT. What is the Diagnosis?

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Tachycardia Cardiomyopathy Electrocardiogram Article 83

Frontiers in Cardiovascular Medicine

OCTOBER 9, 2024

Electroanatomic mapping guides complex atrial tachycardia ablations; however, challenges may emerge after pulmonary vein isolation. 3D mapping systems can reveal the mechanism of tachycardia and critical areas that need to be ablated.

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Ablation Tachycardia Pulmonary 52

Circulation

MARCH 17, 2024

Circulation, Volume 149, Issue 12 , Page 963-966, March 19, 2024.

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Tachycardia Circulation 73

Dr. Smith's ECG Blog

OCTOBER 1, 2024

when the usual negative P wave deflection of sinus tachycardia is nowhere to be found in lead V1 )? While of course possible for the rhythm in ECG #1 to be either AFlutter or fascicular VT — sinus tachycardia immediately becomes a much more likely possibility once we know that this patient is critically ill with multisystem disease.

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Tachycardia Cardiogenic Shock Arrhythmia STEMI 107

HeartRhythm

NOVEMBER 27, 2024

The goals of the current scientific research on ventricular tachycardia (VT) ablation included studies to prove the benefit of early ablation on heart failure progression and mortality and the need to better characterize and treat heterogeneous deep VT substrates. In the last 2 years, 5 studies have taken steps to turn the tide.

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Tachycardia Ablation Heart Failure Research 40

HeartRhythm

NOVEMBER 26, 2024

Atrial extra stimulus testing induced a short- RP tachycardia initiated by prolongation of the AH interval. The response of the tachycardia to ventricular overdrive pacing (VOP) from the right ventricular (RV) apex is shown in figure 1A and the response to atrial overdrive pacing (AOP) is shown in figure 1B.

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Tachycardia Electrophysiology 40

ECG Guru

JULY 30, 2023

A is the first beat of a wide complex tachycardia. This must be a ventricular tachycardia. Although there is a P-wave before the first beat of the tachycardia, it is not premature. The first beat of the tachycardia looks different from the subsequent beats because there is a fusion beat present.

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Tachycardia 98