atrial ecg

[deepurple]

How to do atrial ecg?

First, the pt must have pacing wire from ventricle and atrial

When comes to set up the ecg machine, it become totally mess up.

When print the ecg, he normal ecg will be printed not the atrial ecg.

When pt do have temporary pacer, we disconnected the pacer when to do normal ecg w/o pacer but still have paced, but at lead II no pace.

My question is when do ecg w/o pace, is it only the lead II showed no paced and the rest will showed the paced?

[BelgianRN]

Indeed, an atrial ECG requires atrial pacing wires. The policy in my hospital is that we connect the extremity leads as they should and use V1 and V2 or V3 connected to both atrial wires. I generally use V3 if my complexes are too large and start overlapping with each other. The remaining precordial leads are not always connected. Just remember because your view point for the atrial leads is located in the atrium you'll probaly have large QRS-complexes but also very large P-waves that can easily be confused for QRS-complexes making atrial ECGs harder to interpret.

I'm not sure which pacing ECGs you are taking. But when I have a temporary pacemaker (and I know there is an organized perfusing rhythm underneath) I disconnect the pacing wires from the external pacemaker unit and take an ECG without pacing spikes. I don't use the pause button because our pacemaker units just don't pause long enough to complete an entire ECG without pacing spikes and i'll end up with pacing spikes at the very end of my ECG.

When we take ECGs on people with internal pacemakers we generally first take an ECG in the resting state (e.g. if the pacemaker is pacing we'll take an ECG of that if it isn't pacing we take one of that). Then the pacemaker technician will either mandate the pacemaker to start pacing or switch off so we can redo the ECGs and compare them. It gives great signs of failure to capture etc. But this takes coordination with a pacemaker technician and is not always needed for every pacemaker patient.

Just remember when people have been paced for a while your unpaced ECG might still show abnormalities in repolarisation (e.g. altered T-waves) and can have ventricular conduction abnormalities just because the heart's own conduction system has been bypassed for so long by the pacemaker function.