case 1 khrs arc 2012-basic 51/f, paroxysmal af for 3...

51/F, Paroxysmal AF for 3 years

Preop. Consultation for bradycardia

Medication: flecainide 100mg/d, bisoprolol 2.5mg/d

CASE 1 KHRS ARC 2012-BASIC

HR: 55bpm, no subjective Sx.

What is your diagnosis?

1. Sinus bradycardia

2. Sinus bradycardia with sinus arrhythmia

3. Ventricular premature complex

4. Atrial premature complex



SA

N A

AVN

V

RP:

180ms

RP:

200ms

RP:

200ms

RP:

160ms

SCL:

1100ms

SCL:

1100ms

PP:

1640ms

PP:

1680ms

PP:

1680ms

PP:

1640ms

PR:

360ms

PR:

420ms

LBBB


ECG abnormality on this strip:

1. Non-conducted APC

2. Conducted APC with prolonged PR interval

followed by aberrant conduction

3. Conducted APC with prolonged PR interval

42/M, 선교사 (필리핀 거주)

Consultation for ECG abnl on health examination

Echo: unremarkable


No subjective Sx.


What is your diagnosis?

1. Atrial premature beat

2. Junctional premature beat

3. Ventricular premature beat

4. Non of above


SA

N A

AVN

V

SCL:

740ms

SCL:

720ms

SCL:

1420ms

RP: 60ms

Junctional premature beat


69/M, no prior medical records

c/c: palpitation for 1 month

Echo: unremarkable, Holter PVC 2400/day


SAN

A

AVN

V

SCL:

960ms

SCL:

960ms

SCL:

960ms

PP:

1920ms

PP:

1920ms

PVC with full compensatory pause

SCL:

960ms

SCL:

960ms

SCL:

960ms

SCL:

960ms


67/M, HBP 5 years ago

c/c: palpitation for 2 weeks Initial ECG


SAN

A

AVN

V

RR:

1100ms

SCL:

1040ms

SCL:

1040ms

SCL:

1040ms

SCL:

1040ms

SCL:

1040ms

SCL:

1040ms

RR:

1100ms

RR:

1100ms

RR:

980ms

RR:

980ms

RR:

980ms

PR:

180ms

PR:

240ms

Interpolated PVC with retrograde concealed conduction


37/M, Paroxysmal AF (lone AF), 1st detected

c/c: intermittent palpitation

AF with intermittent wide QRS complex with RBBB like pattern


RR:

1060ms

RR:

760ms

RR:

720ms

RR:

440ms

RR:

440ms

RR:

420ms

RR:

400ms

Short-long-short sequence followed by

different degrees of RBBB

Phase 3 aberration occurs following a long-short cycle

sequence because the refractory period of the beat

following the long cycle is prolonged

Sudden marked shortening of the ventricular cycle

length (phase 3 aberration)

65/M, Flank pain


* **

Atrial couplet

- Blue: sinus P

- *Blue: premature P with normal conduction

- **Blue: premature P with non-conduction


12/F, Nausea


* * * * *

Atrial trigeminy with dual AV nodal pathway

- Blue: sinus P with fast pathway conduction

- Red: premature P with slow pathway conduction

- *Blue: sinus P with non-conduction


* * * * * * * *

Sinus rhythm with dual AV nodal pathway and ventricular triplets

- Blue: sinus P with fast pathway conduction

- *Blue: sinus P with slow pathway conduction

- Ventricular triplets: may be due to pacemaker leads because the QRS

morphology was similar with pacing QRS morphology.

During pacing Yellow: lead of PM


69/M, Syncope


Ventricular tachycardia

- *: capture beat

- **: fusion beat


** *

58/M, Abnormal ECG


Wandering pacemaker


69/F, Dizziness


Junctional escape beats

- Blue: retrograde P


75/M, Dyspnea on exertion


Atrial fibrillation

Complete AV block with junctional escape beats


83/F, Dizziness


Sinus arrest/pause with ventricular escape beats

- Blue: sinus P


30/F, SVT 로 Cath. Room에서 sedation 후 ECG


After Atropine 1 mg IV


Intracardiac Electrogram


Intracardiac Electrogram after Atropine



31/F, Intermittent palpitation with dizziness


During palpitation

After atropine



56/M, Sudden onset anterior chest pain for 1 hr


30 min after thrombolytic Tx


60 min after thrombolytic Tx


Percutaneous Coronary Intervention


50/M, Palpitation

PR interval 220 ms

PR interval 160 ms


AV nodal reentry


24/F, Palpitation


Termination by Adenosine


F/U ECG after Termination

Def. : beat to beat variation in R wave amplitude > 1mm

Favor orthodromic AVRT

Rate-related phenomenon

However, not specific for tachycardia mechanism


QRS alternans during narrow QRS tachycardia


Atrioventricular reentrant tachycardia

89 F, Hypertension Chest pain

KHRS ARC 2012-BASIC

2011-06-18

CASE 18

PCI

2011-06-18

KHRS ARC 2012-BASIC CASE 18

ECG after PCI

2011-06-18


F/U ECG


2011-06-18

2011-06-19

2011-06-19

2011-06-20

83 M, DM Hypertension, Syncope

KHRS ARC 2012-BASIC

2008-11-26

CASE 19

ECG

2008-11-26


ECG

2008-11-28


ECG

2008-12-01


61/M, Feb 10’ AAA rupture (emergency OP) ICU care Recurrent pause during suction/position change

2010-03-21


Rhythm strip during pause

2010-03-21


A

AVN

V

PR : 200ms

PP : 660ms 780 800 1040 920 880 800

810 2580 1800 1040 1460

240 160 160 200

740 880 880 880 720

210 240 320 200

RR : 660ms 720 800

Vagal AV block

• Slinical history highly suggestive of heightened vagal tone (i.e., during

micturition, phlebotomy, etc.),

• Significant PR prolongation or Wenckebach before initiation of AVB

• Prolonging P-P interval during ventricular asystole

• Resumption of AV conduction on sinus acceleration (shortening of P-P

interval)

• No retrograde activation of the His bundle with a ventricular or His

extrasystole to reset and abolish AVB

Heart Rhythm 2009;6:1229 –1234

83/F, AGC ’11 Recurrent syncope

2011-11-15


ECG

2011-11-15


ECG

2011-11-16


Previous ECG

2011-06-11


Trifascicular block

RBBB + alternating LAFB/LPFB Bifascicular block + I AV block LBBB + I AV block Alternaging RBBB/LBBB esp with I AV block

86/F, PTGBD 06.01 Dyspnea

2011-06-09


QTc 642ms K 3.3mmol/L Ca 8.6mg/dL (8.6-10.0) Mg 1.2mg/dL (1.6-3.0)

ECG

2011-06-13

K 3.2 mmol/L

K 3.8 mmol/L

K 4.1 mmol/L

K 4.3 mmol/L


75 M, DM Hypertension, Syncope


2012-04-30

ECG at admission

2012-04-30 K 8.2mmol/L, BUN/Cr 27/1.47mg/dL


FU ECG

2012-04-30 K 4.2mmol/L


case 1 khrs arc 2012-basic 51/f, paroxysmal af for 3...

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