From: thatsuthant <thatsuthant@...>
Subject: [ekg_club] Re: Rare ectopic rhythm
To: ekg_club@yahoogroups.com
Date: Sunday, July 5, 2009, 3:16 AM

Hi every one,
How do you differentiate atrial ectopic beats from ventricular ectopic beats?. Any one can define me please?.
Ventricular ectopic beats are clearly seen on ECG . But atrial ectopic beats, how you all find those?. Please give some of your thoughts.

Thanks

--- In ekg_club@yahoogroup s.com, Klaus Skrudland <lapsklaus@. ..> wrote:
>
> Hi all. Just want to present to you a case of what I believe is a quite
> uncommon ectopic rhythm.
>
> The patient is a 55 y/o male with a well known paroxysmal atrial
> fibrillation. He uses flecainide and metoprolol and was admitted for onset
> of what he thought was atrial fibrillation.
>
> As you will see from the ecg, the ventricular rate is irregular. Right
> precordial leads show ectopic, positive P waves. PP intervals are regular
> with a rate of 230 bpm. When marching them out with a caliper (see the dots
> I made), they seem to march right through the QRS complexes and donīt seem
> to get conducted. However, there canīt be AV dissociation, as there is no
> evidence of an escape pacemaker present (and the ventricular rate is
> irregular).
>
> As a matter of fact, the P waves does seem to get conducted after all. My
> colleague Terje (the other Norwegian here in the club) pointed out that the
> PR interval in fact gets progressively longer. And at this point, Iīm
> struggling to understand the rest of the mechanism. Most likely, this atrial
> tachycardia with some kind of Wenkebach conduction.
>
> Comments? Thoughts? Ideas? Anyone wanna make a ladderdiagram to explain the
> mechanism?! ;-)
>
> klaus
>