AF or AFL or Artifact

[Dsmcmm]

Here is an example of what? AF or AFL or Artifact. Note QRS complexes clearly defined. Looks to be SR but possible slightly irregularly irregular? Also PACs and PVCs in ECG.

Thanks for feedback!

Shutterfly

[chare]

Thank you.

Question: Given the QRS complexes have no artifact to them, could these waves be F-waves with (5-1, 6-1 conduction ) resulting in NSR? I cant make out P waves but I trust your read.

The QRS complexes will not show artifact as such.

However, if the artifact were of significant amplitude it might cover the QRS, but it won't affect the QRS morphology.

Fibrillatory waves ( AFIB) line 2. Fine amplitude. This is my question.

S is Sinus

Thanks.

No, there are no F waves on line 2. This is artifact. If you measure the R-R intervals you will find that they are consistent. If this were a-fib this wouldn't be the case.

Paroxysmal AFib. Is a sudden onset and termination from seconds to days according to Cleveland Clinic.

I'm curious, what exactly do you see in this rhythm that seems to convince you that this is a-fib?

[Dsmcmm]

The R-R intervals change by 80ms-40ms-80ms. They are not consistent as prior to the PVC. Given the changes are small, but there is change to rhythm. A conduction delay with any type of heart block could keep the HR below 100 and further more below 70. the method I used was to mark the rhythm prior to and after PVC and transfering to R-R. I see no P waves during the episode of (artifact or Afib) leading to my questions. There are many documented cases of (athletic Lone afib) with HR well below 70

[Dsmcmm]

The QRS complexes will not show artifact as such.

However, if the artifact were of significant amplitude it might cover the QRS, but it won't affect the QRS morphology.

No, there are no F waves on line 2. This is artifact. If you measure the R-R intervals you will find that they are consistent. If this were a-fib this wouldn't be the case.

I'm curious, what exactly do you see in this rhythm that seems to convince you that this is a-fib?

The R-R intervals change by 80ms-40ms-80ms. They are not consistent as prior to the PVC. Given the changes are small, but there is change to rhythm. A conduction delay with any type of heart block could keep the HR below 100 and further more below 70. the method I used was to mark the rhythm prior to and after PVC and transfering to R-R. I see no P waves during the episode of (artifact or Afib) leading to my questions. There are many documented cases of (athletic Lone afib) with HR well below 70

[MunoRN, RN]

There is artifact in line 2 and the beginning of line 3, the waveforms are too sharp and erratic to be consistent with any type of intrinsic conduction.

There are P-waves present throughout the strip, there is an early beat in line 2 that is either a premature junctional contraction or possibly a premature atrial contraction where the P wave is buried in the preceding T wave.

All impulses that originate in the atria are P waves, a-fib atrial waves as well as atrial flutter waves are both types of P waves.

Irregular R-R intervals don't define a rhythm as being A-fib since there are multiple reasons for varying R-R intervals, with A-fib being just one of the possible explanations.

[2210485]

Edit: ok so i downloaded it and was able to expand it a bit.

100% not flutter at any point. The cycle length is too short, basically it takes an electrical impulse a specific amount of time to travel from 1 area of the atria to another, if that time is not met the impulse is originating somewhere else. The majority of flutters follow the same track, so if we assume the case is typical we can predict whether the flutter is legit using this timing.

Soo.. I stand corrected, its very likely afib. Change in qrs amplitute signals a rhythm change.. And the fact that it cleaned up with ectopy is suspicious.

Afib can be identified by a-a (atrial to atrial) variability over 18 ms (we have that in those sawtoothed areas), r-r variability over 30ms not attributable to an absence of electrical activity (due to a pause, dropped beat or sinus arrhythmia variabilities.. Basically there should be an abundance of electrical activity and a definitely high atrial rate.. We have that.) and atrial waveforms less then 203ms (average flutter cycle length.. Were less than that). Whether or not you see a pwave or flutter wave or whatever isnt necessarily very important to identifying afib, as a fib can produce 'pseudo' pwaves or flutter waves in some circumstances, we can see this in the area in question, theres a convincing looking pri. Its still hard to see the strip on a phone, and without v1 to look at diagnosis is extremely difficult.

V1 lies in close proximity to the right atria and generates an extremely useful map of the electrical vector there. So in an ideal situation 2 strips.. 1 of v1 and 1 from lead II taken during the same time period (as would be present in a 12 lead) is sufficient to distinguish a fib from flutter and to predict whether a circuit is typical or atypical clockwise or counterclockwise.

Using 1 strip of unknown origin lowers my confidence by about half.

[RescueNinjaKy]

I think it's sinus rhythm with pac/pvc and some compensatory pauses.

[bgxyrnf, MSN, RN]

I see P waves... mostly clearly on the first line and the first couple beats of the second line. They get lost in the artifact and then are not visible in some beats and in others are just a slight blip on the line.

You're seeing one of the inherent weaknesses of looking at only a single lead. Sometimes waves are not visible on one lead but are on others.

Rhythm leads are just gross overviews of the general rate and rhythm. To make any real determination about the conduction, you really need the 12-lead.