Nelson ECG review April 2015

  1. Ectopic atrial tachycardia with block suggests digitalis excess. Don’t forget to find for the inverted P waves !
  2. Endless loop tachycardia in dual chamber pacemakers
    – Normally when intrinsic P wave is detected, the atria pacemaker is inhibited and the ventricle’s one fires.
    – However, if there is an alternate pathway enabling the retrograde conduction of the ventricular impulse, it will be misinterpretated as P wave. Atrial discharge is blocked but the ventricular pacemaker fires.
    – Endless loop = ventricles -> atria -> ventricles -> atria -> ventricles -> atria……..
    – Look for the pacemaker spike, it can small !
  3. Grouped Aflutter beats: think of bilevel AV block.
    Picture1
    – This nice example is gotten from Dr Nelson’s slide in may 2015.
    – In upper level, there is 2:1 conduction. In lower level, there is 3:2 conduction.
    – Clinical significance: when you are trying to treat AFT with AVNB it may cause Wenckebach to develop below the upprer filter. It is perfectly okay, and not something to be worried about.
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