I'll start by saying that the diagnosis of IAB isn't entirely clear to me, but how can I rule out pre-excitation in a patient complaining of palpitations and this ECG? A patient with IAB could also have pre-excitation, right? 🙏

Thank you very much, The pic is a bit blurry, could it be IAB, then? The PR is short too, right?

A sixty-year-old patient with a history of palpitations. I was reasonably convinced it was pre-excitation, but the EPS showed S/F AVNRT. When the presumed/suspected pre-excitation is subtle I always have many doubts🤔 @narrowqrs.bsky.social @jeffreyvinocur.bsky.social 🙏

Thank you. I'm keeping my promise. See you on the next case ☺️

Thanks for your patience! I think there may be progression of damage from the AV node to the His Purkinje system, right? If so, after how long? 🙏 I'll stop here with this case, I promise ☺️

I reviewed the ECGs in the medical records of the patients who were admitted on the same days as this patient who received the pacemaker and none of them had a wide QRS

It's happened to me several times too. In this case, however, we have 4-5 ECGs performed by different nurses on different days with the same name listed (that of the patient who had the telemetry) 🤷.

I was also wary when I saw them, but the ECGs in succession have the same name of the patient on several days (there were no namesakes in the department, I had also thought about this possibility), the telemetry at that time was the only one, however unlikely I cannot imagine an alternative

I know it seems strange, but I don't know what to say🤷

Good morning @narrowqrs.bsky.social. The patient underwent PM implantation. These are the ECGs during hospitalization up to the time of implantation. QRS complexes always narrow, regarding telemetry I checked: on the night the PAVB occurred there was no other patient with telemetry

Thank you. I admitted the pt when she came to the hospital. I certainly didn't perform the ECG myself, but it was done in the ED. I wasn't on duty the next day, and they sent me this photo from the hospital where the patient was being monitored. I'll try to get the 12-lead ECGs in the next few days.

Yes. A 76-year-old woman with HTN slipped on the steps and fell, hitting her head. She likely lost consciousness for about a minute after the injury.
ECG upon arrival in ED.
Telemetry after ~24 h

Good morning @jeffreyvinocur.bsky.social @narrowqrs.bsky.social. I interpreted this ECG ( left) as Mobitz 1, narrow QRS with probable nodal block, PVC.
On the right after 24 h in telemetry. I wonder: was the block in the first ECG really nodal? Thank you in advance.🙏

Yes! Your first observation is the expected behavior. Your second observation is the unusual finding.

Thank you 🙏

At the end of the trace is there a block in the AP too?🤔

Thank you for sharing, if I understand correctly, adenosine-induced AV node block makes AP conduction more evident, right?

#EPeeps fascinating adenosine response

Thank you very much 🙏

Thank you so much, that was exactly my idea. Can we rule out PAC or atrial retroconduction because Ab corresponds exactly to VS, is that correct?

I think sinus with FFRW oversensing and a PVC?

Good morning @jeffreyvinocur.bsky.social, could you please help me interpret this event? I have some ideas, but I need expert confirmation. Thank you.

Thank you very much. From this morphology I wouldn't have said it

IMO: flat line in DII ➡️ RA/RL lead reversal, SR with pseudofusion beats

#EPeeps Cute variant on a common ECG issue

Have your patients been under the false impression that slow pulse = sinus rhythm? This direct link helps educate about the difference between rate and rhythm:

www.youtube.com/watch?v=oy9g...

Here are the topics from the a.fib video 👍

Here's a simple explanation for patients about electrical cardioversion:

(link goes right to this spot in the video)

www.youtube.com/watch?v=oy9g...

Walking a patient through an a.fib ablation procedure:

(Link goes directly to this part of the video)

m.youtube.com/watch?v=oy9g...

#EPeeps It's not very exciting, but I see this get missed over and over. Less subtle repeat in the thread.

#ACHD